Wife has just tested positive for HepC

[Cure]

Hello,

I am a newlywed and my wife has recently tested positive for HepC.  I love her very much and she is a wonderful person that I'm trying my best as a husband to help her fight.

I have read that their are cures now, that come with an insane price tag.  We are in our early 30s and I wanted to know a few things.

-Has anyone in a similar situation been able to get their insurance companies to pay for the HepC treatment?   I'm afraid we'll be denied because she is young and newly diagnosed.

-Has anyone used or know in more detail about Zepatier form Merck?  If so, do they have any programs that we could apply for to get a discounted rate of the drug?

-Also, I've read of a man name Greg Jefferys, has anyone sought out his services on these forums?

I have read through these forums and knowing that a support structure like this exists brings us hope and gives us a positive outlook to our situation.

[Coach Mike]

Hi,
Read all my posts. Check FixHepC.com. You can go with Greg, but there are cheaper ways. He is dependable. Also, check out the Delphi site in my signature. You can get insurance to pay, but it can take a long time. If you have $900, she could be taking her medicine in 10 days.
GP2U.com can get her in the REDEMPTION clinical trials for $2000. It has a 95% SVR 4 rate. Early results are going to be presented next month at EASL.
Now, more on insurance: It took me 7 months to get to see my GI to get my last prescription. That was my 3rd. I had to fight them through three denials until I was approved by the independent external review based on severe EHMs. The insurance companies have eased up on their restrictions, but think in terms of months or more to get a shot at her being approved. There is a lot to learn. You have started in a good place. More info would help people give you better advice. Genotype, etc.
Good luck.
CM

[Cure]

Hi,
Read all my posts. Check FixHepC.com. You can go with Greg, but there are cheaper ways. He is dependable. Also, check out the Delphi site in my signature. You can get insurance to pay, but it can take a long time. If you have $900, she could be taking her medicine in 10 days.
GP2U.com can get her in the REDEMPTION clinical trials for $2000. It has a 95% SVR 4 rate. Early results are going to be presented next month at EASL.
Good luck.
CM

Isn't it difficult to get something from Beijing Mesochem to the US?

[Coach Mike]

No.
Register at FixHepC.com. I am a moderator there. I generally send a PM to all new members. If I don't, send me one.

[Mike]

Hi,

Being a women of child-bearing age with the intent to have children is a qualifier for many insurances plans. You may want to discuss this with your wife and doctor.

Best wishes, Mike

[Coach Mike]

Good points Mike,
That is what insurance is for. Find a doctor, tell him or her you want to start a family yesterday. If they won't fight for you, find another one. In the meantime, get all the tests: fibrosure or scan, viral load, CBC, CMP. Get copies and scan them for future use, along with a written copy of the medication prescribed. If the insurance company tries to stonewall, you will have the documentation needed to use your other options. Play the "wanting to start a family" card first. If you are denied, then you will probably be looking at a fight for insurance coverage.
At least now there are viable, affordable, proven alternatives.
I know, I got the generics and fought and got insurance coverage.
It can be done if you fight.
CM

[J.R.]

Cure,
Coach Mike gives some good advice, but "your mileage will vary" will dealing with treatment. On the flipside, I had a doctors visit the last week of January, informed my GI I wanted to start treatment. He ordered the necessary tests. Less than two weeks, insurance notified me they approved treatment (harvoni) and NO $$ as between my and spouse's insurance it was covered.  I started taking Harvoni the weekend after Valentines Day.
And as CM said, get the necessary tests done so the GI doctor can set a course of treatment for your wife. Praying for a positive outcome.

[Coach Mike]

More good points JR,
It all depends on how you, your doctors and your insurance company can work together and get it done. That hard fact is this: the insurance company will have to pay Gilead, or whoever, $40,000+ for the treatment. Anyway you view that, its a lot of money. So, they might just pay up or try to stall. Whatever happens, someone has to foot Gilead's bill. Insurance companies are businesses. You don't read about them going broke. Premiums will rise. In the end, the clients will foot the bill.
Gilead spends $99 on advertising for every dollar spent on research. I can document that.
If I seem bitter, its because I am.
This is simply wrong.
They have made enough money on sofosbuvir. Its time for the price to come down to a realistic level.
The global market seems to place that around $1000 for a 12 week tx.
Don't get me wrong here, go after your rightful coverage and fight like hell if need be.
Wishing you and yours good luck,
CM

[Cure]

Cure,
Coach Mike gives some good advice, but "your mileage will vary" will dealing with treatment. On the flipside, I had a doctors visit the last week of January, informed my GI I wanted to start treatment. He ordered the necessary tests. Less than two weeks, insurance notified me they approved treatment (harvoni) and NO $$ as between my and spouse's insurance it was covered.  I started taking Harvoni the weekend after Valentines Day.
And as CM said, get the necessary tests done so the GI doctor can set a course of treatment for your wife. Praying for a positive outcome.

Thank you all for the help and support.  Another question I have is what insurances have you guys used that hasn't given too much push back to get your treatment?

Our current insurance is Kaiser in Virginia and I'm dreading the idea that they are going to reject us.  If they do, I wonder if I am able to switch to another insurance company that would more likely cover my wife's treatments?

[Coach Mike]

Hi,
You need to ask Kaiser for a copy of or a link to their criteria for treatment of HCV. That will give you a better idea of your chances. If you are considering switching companies, the same applies. They are going to have to pay $40,000+ for the medicine. Many are difficult to deal with. Some, far worse than others.
My BCBS was horrible. Maybe some of the people who breezed through the approval process could give you a company name. I read about people saying how easy it was, but don't see many insurance companies being mentioned.
Knowing what I know now and given the current situation with generics, I wouldn't fight them 2 years for coverage.
I would simply pay the $1000 and get well.
CM

[J.R.]

Cure,
My insurance was Anthem Blue Cross. As one poster mentioned with your wife being of child-bearing age that should be her ticket to qualify for treatment. Let her PC know you are wanting to start a family. Then a referral to GI should get the ball rolling for you.

[Coach Mike]

Thanks JR,
Knowing that a company has approved soneone for expensive drugs gives hope.
Hope used to be about all one had when dealing with this crap.
No more.
CM

[Baxter]

From a pure cost/benefit perspective, it seems to me that paying for the treatment now rather than a transplant and a lifetime's worth of anti-rejection drugs later is the more pragmatic decision for an insurance company. As expensive as it is, the numbers only get bigger the further down the road you go. What am I missing in this equation?

[Coach Mike]

I offered to buy Harvoni out if my pocket at 100% co pay if my insurer would approve coverage. I simply wanted to be able to get it at their discount. Their answer: " We don't negotiate". Thats how stupid they can be. After all, its not like they are going out of business. They will get their money back in higher premiums. Never heard of a health insurer going broke. They need to send their clients to India. They could save a ton. But, its not their money.....
The bad guy is Gilead. The good guy is generics.
CM

[lporterrn]

Cure - I think that your questions about coverage and considering generics are premature. If you wife says she is wanting to get pregnant, she is very likely to get treatment approved. Rather than speculate, I suggest seeing what happens. Too soon to assume there will be obstacles.

[Coach Mike]

Lucinda is right.
Thats what insurance is for. Start the process, because thats what it is, a process. From diagnosis, to the GI appointment, to the insurance company, to the specialty pharmacy. It is a process. One step at a time.
Maybe, in a few years, it will be like a bladder or prostate infection, go to your PCP after the diagnosis and tests, get a prescription called in and pick up your medication. I have never seen a GI for my HCV, only an APN. If no other issues are present, treating this disease is fairly simple.
Start the process.
CM