Starting Harvoni, ExpressScripts woes

[flotcho]

Hi folks, my first post here, but I've been reading and gaining a lot of knowledge from this forum for a while.
I was diagnosed back in '04, and a biopsy at that time showed no severe damage, so my doctor and I agreed to delay treatment for a year or two. During that time, I decided that the treatment was going to be as bad as the disease, so I delayed it until now. About 2013 I started really feeling bad, losing energy and appetite, and so went in for testing. An endoscopy revealed to my doctor that I now have cirrhosis.
My doctor prescribed Harvoni in early December of 2014. My insurance through my employer, BC/BS and ExpressScripts, wanted additional testing, they said. What they really wanted was to delay until after the first of the year. Needless to say, they declined coverage for Harvoni, and "recommended" Vikera Pak. Either of these treatments would have required a 12 week course for me, but in my case, because I am genotype 1B, the Vikera Pak would also require ribavirin.
After talking with ExScripts on the phone numerous times, and receiving another letter declining coverage for Harvoni, I got a call from the local specialty pharmacy saying my doctor had approved Vikera Pak.
I contacted Gilead SupportPath, and explained my situation to them,and sent them the admissions form and notices from ExScripts declining coverage. Meanwhile, I got a notice from ExScripts questioning coverage for the ribavirin that was prescribed with the VikeraPak! (They did not actually decline coverage, but were using their typical stalling tactics.)
I saw my GI on 3/18, and we agreed that I could not afford to wait much longer for treatment - we agreed if I could not get covered for Harvoni within a month, I would take the Vikera Pak. When on Thurs. 3/19, I checked my voice mail, and there was a message from Support Path saying that they were going to cover me for 12 weeks of Harvoni! I called them on Friday 3/20 to confirm, and make sure I didn't need to do anything else, and they said it was already in the mail to my doctor's office! Wow.
So, it looks like starting this week, I'll be joining the ranks of those on the road to recovery.
I apologize for the length of this post, but you know, first post and all that. There is actually quite a bit more to this saga, but I'm leaving it out for the sake of brevity. One other note - I work for a very large corporation, who provides my insurance, and I WILL be contacting some people way up on the corporate food chain about their choice in insurance/prescription providers. I'm very thankful that I am going to be covered for treatment, but it just infuriates me that, especially given what I pay for my coverage, my insurance company is so sorry and unethical.
But, aside from that, I'm a very happy man! 

Thanks to all of you for this very supportive forum.

[BubbaT]

Hey flotcho,

Welcome to the forum of the recovering!  We are in this together fighting to live, and
Glad to support you on the way, you will notice at the bottom of the post is a signature line that gives you our rank and serial number! Lol. How tuff we are!

But, we are a determined bunch so grab a chair and hang on!  Glad you finally got some meds to fight back with...

Warrior friend...

[dragonslayer]

>>but in my case, because I am genotype 1B, the Vikera Pak would also require ribavirin. <<

Flotcho, if Im not mistaken, its the Genotype 1A which requires Riba with the Viekira Pak.  The gt 1b does not.  I believe the reason you need Riba is not your genotype but your cirrhosis.

[SIXFOOTFOUR]

I went through the same problem with Express Scripts, denied and then tried to get me Viekira Pak. My Dr followed up and I ended up getting harvoni from a different pharmacy and a phone call from express scripts that it was approved so I started 3 weeks ago! If I was denied 1 more time I think I would have started the Viekira since the success rate is almost the same just more pills a day and a chance of more side effects and followup labs than the Harvoni

For any of you that have Express Scripts they want to approve Viekira because they worked out a discount pricing but if you are F3 or above stay with it , it can still be approved by Express Scripts and they will have it filled by Accredo their specialty provider.

 

[flotcho]

Paul, I re-checked AbbVie's dosing info, and you are correct - it is the cirrhosis that , in my case, requires the riba. That is not what I remember seeing on their site a few months ago, but my memory a'int so good either. Anyway, I should have Harvoni here within the next day or two, just waiting on the call from my doctor's office.

[flotcho]

Picked up my first four weeks Harvoni yesterday, and started treatment this morning. I have a good friend who just finished 12 weeks on Harvoni, and got the this past Tuesday that he is virus free! Hopefully, I'll be getting similar news sometime around the end of June!