Author Topic: Insurance and co pay problems (Read 22015 times)

Shovelhead · « **on:** December 03, 2014, 11:05:01 pm »

Hello,
It has been comforting to read the posts on this forum, however, we have not seen any comments on our biggest issue- paying for this miracle cure!
Started Harvoni on 11/6. Treated in 2003 with the "wanted to die" treatment for 24 months. rediagnosed with Hep C Oct 2013.

Tried to get on S/O with no luck due to incredible high copay and PAP not paying enough either. dr suggested I wait until Oct 2014 to start new "cure" Harvoni.
I was given the 1st 28 day Rx for $5 copay thanks to the Gilead's Q-pon, my insurance paid the other 50%. I thought I was set, even confirmed my co-pay for the expected 8 week treatment would only be $5. Today I called to get my 2nd month of Harvoni only to be told I need to come up with $9,000 copay! Needless to say I nearly collapsed right there. I am 1/2 way thru treatment, need my pills by Monday and am so distraught that I feel hopeless.
My side effects so far have been minimal especially when I compare the treatment I went thru in 2003, it was HELL and many days I just wanted to die.
So far, 24 days in, I am having brain fog for the last 3 days, headaches, upset noisy stomach, gas. Insomnia has been present nightly since treatment began. Hoping this gets better as I continue to work full time and am struggling to get thru my day due to fatigue. If anyone has advise on how to get this cure at little to no cost Input would be very appreciated. It does help to know I am just one of many people who have been dealing with this virus for so long.
Hope I get some answers soon or I will need to stop treatment and just let this take its natural course. I hear if I was not insured or working it would be covered 100%, sad that someone who has always worked gets the short end once again.

Lynn K · « **Reply #1 on:** December 03, 2014, 11:54:54 pm »

Contact Gilead support path tomorrow morning!

The copayment should be good for your whole treatment

http://www.mysupportpath.com

Providers and patients can call 1-855-7-MYPATH (1-855-769-7284) for assistance

Good luck
Lynn

Shovelhead · « **Reply #2 on:** December 04, 2014, 07:48:27 am »

Lynn
Thank You.
I have a few folks to call and they will be one of them.
I will post again with the results.
To those who are just starting this med, be prepared for the guantlet.
Keep your notes, whom u spoke to, when etc..
This process needs serious improvement.
Thanks again for reaffirming I am mot alone in this journey.

BattleTheBeast · « **Reply #3 on:** December 04, 2014, 02:55:53 pm »

Quote from: Shovelhead on December 04, 2014, 07:48:27 am

Lynn
Thank You.
I have a few folks to call and they will be one of them.
I will post again with the results.
To those who are just starting this med, be prepared for the guantlet.
Keep your notes, whom u spoke to, when etc..
This process needs serious improvement.
Thanks again for reaffirming I am mot alone in this journey.

Keep Positive Shovelhead! Go take a ride on that bike before the bad weather kicks in, let the stress out. It's going to all work out! I am fighting my way through some challenges as well.

~Mel~

Bucky · « **Reply #4 on:** December 04, 2014, 03:47:08 pm »

Shovelhead,
Welcome to the forum. You are not the first one to post about the second month surprise.
Bucky

Shovelhead · « **Reply #5 on:** December 04, 2014, 08:57:29 pm »

Update:
Finally got my co-pay covered in full via PAN. Hopefully i can be finished by 1/6, just waiting for my layest blood results.
Not sure how the payment happened and hoping it will rollover into the new year.
Feeling much better today.
This forum helped me calm down, regroup and reaffirmed that we are not alone in our battle.
I will repost soon with good news

BattleTheBeast · « **Reply #6 on:** December 04, 2014, 09:44:06 pm »

Great news already Shovelhead! Now you can just focus on beating the beast!!

~Mel~

cathy · « **Reply #7 on:** December 07, 2014, 04:35:48 am »

This is the first time I am in this forum. I've had hepatitic C for approximately 30 years, but was diagnosed 15 years ago. I now have cirrhosis, compensated. I am going to my doctor Thursday and he will start me on Harvoni. I am on Medicare and have a United Health supplemental. Does anyone know the co-pay.

Lynn K · « **Reply #8 on:** December 07, 2014, 04:53:28 am »

Hi Cathy
you can go to HARVONI Support Path from Gilead the maker of Harvoni. Ther are providing copay assistance so that you will only pay $5 per refill.

Check it out at
https://www.harvoni.com/support?evo_source=MYSUPPORTPATH&_ga=1.211600917.168650244.1417945714

CO-PAY COUPON

The HARVONI and SOVALDI co-pay coupons can help lower out-of-pocket costs for patients.

Most patients eligible for this assistance will pay no more than $5 per co-pay.
Providers and patients can call 1-855-7-MYPATH (1-855-769-7284) for assistance

Good Luck
Lynn

Shovelhead · « **Reply #9 on:** December 07, 2014, 11:21:12 am »

Latest news. Viral load on my 4 week bloid test came back 0! Yea, feeling like there is hope i might best this afterall.
Wishing u all good news too.

Mike · « **Reply #10 on:** December 07, 2014, 11:26:06 am »

Congrats Shovelhead! These new drugs are game changers!

Looks like another dragon is going down!

Best wishes, Mike

BattleTheBeast · « **Reply #11 on:** December 07, 2014, 12:32:30 pm »

Quote from: Shovelhead on December 07, 2014, 11:21:12 am

Latest news. Viral load on my 4 week bloid test came back 0! Yea, feeling like there is hope i might best this afterall.
Wishing u all good news too.

Great news Shovelhead!!

cathy · « **Reply #12 on:** December 07, 2014, 01:05:50 pm »

Thanks Lynn.

I will try, but when I inquired about it on the internet, it said I made too much money. What a joke.

Cathy

Islandgirl · « **Reply #13 on:** December 07, 2014, 01:35:03 pm »

Hi Cathy,
I have Humana Medicare PPO plan and the co-pay would have been WAY too much - my Specialty Pharmacy, TLC, helped me find funding for co-pay assistance. I didn't know this was possible until my insurance approved me (they didn't drop the bomb on how horrific the co-pay would be but TLC told me what the paperwork they got said) and I got the insurance approval letter and a call from TLC the same day.

TLC immediately began checking on co-pay assistance RIGHT THEN and got me approved while I waited on the phone and answered some basic questions. Ask your doc which specialty pharmacy he/she uses and talk to them about co-pay assistance.

I'd call the support path people rather than just checking on line, they say they are there to help - circumstances like ours don't fit in a one-size-fits-all format like you get online - so get them involved in helping you. I know you can get some assistance somewhere - don't give up or let yourself get too down thinking you may not be able to afford this after all (like I did) - keep positive and keep asking questions - help can be found! Good luck! OK, a hug should go with this pep talk, so feel a hug

... Islandgirl

Lynn K · « **Reply #14 on:** December 07, 2014, 03:53:56 pm »

Hi Cathy

I called Support Path when it looked like I may not be approved.

They do have a limit on how much you can make to get the meds paid for by them if your insurance won't. That limit it $100,000 household so I didn't qualify for they to pay for the meds.

Fortunately I convinced my insurance to cover me. I am getting the copay assistance even though my income is too high. They never asked how much I make for the copay assistance so I pay 5 dollars a refill.

I suggest you call them and ask about the copay coupon there is no upper limit fior that as far as I know like I said they didn't even ask me.

The only potential problem I see is maybe the Medicaid but I would still call 5 dollars a bottle is a good thing.

Good luck
Lynn

pappy · « **Reply #15 on:** December 07, 2014, 11:05:48 pm »

I was denied by my insurance at first later I discovered it was a formula dispute between my doctor and the insurance . Doctor tried to do a 12 week dose for my HEP C 1A and the insurance company will only pay for 8 weeks . I am ok with any outcome that gets me treated and to that end i"m on my second day after a month long wait .

P.S. just tell the insurance you have a coupon copay is $5

icantwait · « **Reply #16 on:** December 12, 2014, 04:30:58 pm »

I have a feeling that the insurance issues with Harvoni and other treatments will get worse before they get better. Gilead took a risk when the purchased Pharmasset who developed Sofosbuvir for 11 billion dollars in 2011. Gilead has recouped their investment and are now reaping huge profits. We live in a capitalist society that has driven research to develop new drugs in this country. Gilead is responsible to maximize profits for it's shareholders and hopefully will balance the health of the estimated 3.2 million HCV infected with that responsibility. At the current cost, treating all of them would be more than one 1/4 of the annual Federal budget| The $94,500 price for 12 weeks of treatment must, and will come down. They have licensed several pharmaceutical companies in India to manufacture the drug. The first products are probably a year out yet. The cost will come down with medical tourism pressure once that happens.
Medicare, insurance companies and Express Scripts are struggling with the current costs. They have no choice but to try to delay coverage as long as possible and to prioritize the treatment. It is causing anxiety and frustrating for those that do not have insurance or cannot get it approved to know that the virus is causing damage and a possible earlier death that could be prevented.
America is a great place to live and offers opportunities that we are fortunate to have. This is a tough issue, both monetary and ethically with no simple solutions. I would not want to live in a socialist country with really high taxes and stifled innovation. I hope, but realize that some people will die waiting for treatment. This issue will gain more and more publicity in the coming year. I plan on writing my local senator and congress members to increase their sensitivity to the issue.

icantwait · « **Reply #17 on:** December 12, 2014, 08:32:16 pm »

Correction: I hope, but realize that some people will die waiting for treatment.
Should be: I hope that no one will, but ....

pappy · « **Reply #18 on:** December 13, 2014, 01:02:47 am »

They (the insurance company ) has now told me they have reduced the prescribed amount from 12 weeks to 6 !

Lynn K · « **Reply #19 on:** December 13, 2014, 03:25:56 am »

Hi Pappy

That isn't even per the prescribing information. The only options are 8 or 12 without cirrhosis and 24 if you have cirrhosis what the heck are they thinking! That is really strange. I hope they sent you the wrong information and they meant to say 8 weeks.

Good luck
Lynn

pappy · « **Reply #20 on:** December 13, 2014, 03:47:48 pm »

No they even sent that letter to my doctor and he is pissed .

Islandgirl · « **Reply #21 on:** December 13, 2014, 04:09:47 pm »

Hi Pappy,
That's terrible! My 2 cents, for what it's worth, would be to not only have my doc fight it but to let the people at the Support Path know about it and see if they can help - they've been most helpful getting insurance companies on board from what some people on this forum have said. Can't hurt ...Islandgirl

Wishing you a positive and "right for you" outcome!

Lynn K · « **Reply #22 on:** December 13, 2014, 10:20:20 pm »

Wow what the heck is going on there with your insurance company they are going above and way, way beyond I guess they think they are doctors now.

Wow.....

BattleTheBeast · « **Reply #23 on:** December 14, 2014, 10:19:10 am »

This is insanity! I found out last week when I saw my IDhero that he was put on the phone with a Marketing Major at Accredo regarding my move to Harvoni. He said he went a little apeshit on her because how the heck is a person with a degree in marketing going to understand anything clinical he is discussing with her, he said he even had to spell "r a s h" for her. He was appalled and could not believe they didn't have someone with a medical background talking to these specialists who have spent decades studying Hepatitis. The whole time he told me the story he was holding my hand.

Some how from coming at them from multiple angles *angels* we got my approval but not because the insurance (pharma distribution) Companies are doing the right thing!

I am going to get better and when I do I am going to do what I can to help others get their medication, this is insanity!

M

HHburme · « **Reply #24 on:** December 14, 2014, 10:34:13 am »

Battle....I agree with you. I too feel compelled to help others get treatment . Fight the good fight !

Islandgirl · « **Reply #25 on:** December 14, 2014, 11:38:26 am »

OMG, Mel! A Marketing Manager?

I guess they think your doc just has nothing better to do than help that idiot spell "r a s h"

?? In a word - LUDICROUS!!

Insurance companies seem to be playing doctor and trying to manage them and us more and more. From my 91 year old mother's medication - forcing her to try a new drug and spend $$$ to find it didn't work for her before approving an alternative, even when her doc appealed and told them the one he prescribed was needed - and now the incident you shared.

Much of this is connected to MONEY. Off and on I get a call from my insurance co "offering" me the option of their at home service where a nurse comes out to visit periodically.... Of course, this just provides them an even greater opportunity to butt into your personal life and information. I always decline (maybe if I were bedridden I'd feel differently). I feel it's a waste of funds that could be used in better ways and why would I want that service of an unknown person when I have my doctors and their nurses available already. Will we wake up and find we're only dealing with insurance company personnel instead of our own selected providers?

OK, I'll get off my soapbox now. Whew! ....Islandgirl

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Author Topic: Insurance and co pay problems (Read 22015 times)