Testing while on Harvoni and insurance companies/policies that cover Harvoni

[mvnwy]

Hi, I am new to this group.  My doctor and I want me to start Harvoni as soon as possible. 

I am in the process of trying to decide whether to keep my cheaper insurance policy that most likely will not cover the drug or get a more expensive policy that may cover the drug but can't find out for sure if it will.  My doctor's M.A said that insurance companies had been paying for Harvoni but recently they have mostly not been paying. 

I have two questions for anyone who has had experience with what I need to know.

1.  How often is testing done before, during and after treatment?  And what tests are done?  If I choose the policy that does not cover Harvoni (and get the drug covered via support path, whom I have already talked to and I qualify) I am wondering what the other expenses are besides the drug in case that might not be covered, either. 

2.  What marketplace insurance companies and policy levels (bronze, silver, etc) are known to have covered Harvoni so far? 

The difference in the price of monthly premiums is enough that it will be a hardship, especially if I have side effects which will keep me from working as much because I am self employed.  (historically I always have side effects, even with drugs that do not affect most people!)

Thanks!

[Luna7]

Welcome to the group.

I just dealt with the insurance thing awhile back and I can't say I know for sure I picked the right one. They don't make it easy, plus companies keep changing what they will/won't cover.

Maybe somebody else can estimate what these tests cost, but from what I've read so far it seems you need a lot of tests and they are expensive even with a 20% copay, so my best guess was to pick a plan with a low deductible this year even though my premiums are a bit higher.

[mvnwy]

Thank you , Luna7.  That's very helpful.  That's what I was thinking would be the best bet but it's so hard to make these decisions alone.  Your feedback helps!

[Luna7]

You're welcome MVN.
I forgot to mention, though you probably discovered this, that drug coverage is much better on the Silver plan (in terms of copays).

For awhile I thought trying for disability/Medicare might be a good option, but I see they are now enforcing rationed care to those sickest in a few states and am wondering if other states will follow.

I'm self-employed too and worry about side-effects as well, and also am very sensitive to drugs. This is why I'm trying to avoid the Ribavirin often used for Genotype 3.

[BattleTheBeast]

Luna,

If you do get into a clinical trial everything is covered so no worries about any costs. That's really important to so many people who don't have decent insurance and the money for all the co-pays involved.

Between that and the "must" on the biopsy I didn't even try to get on the trials because there are so many less fortunate people than me who can't afford to be treated and I'd rather give a spot to them! I talked to my Doctor about it and he understands but he said if I was GT2 he would have insisted because they aren't as common. 

MVN,

Welcome to the forum, so happy you are sharing your experiences with us. I don't know much about these new insurance plans but lots of others will be able to give you feedback. A clinical trial may also be an option for you

Happy Sunday!

Mel

[mvnwy]

Thanks, Luna And Battle!  I will make the final decision regarding insurance tomorrow.  Looking like silver plan will probably be the way to go.