Author Topic: United Health Care and Harvoni (Read 31770 times)

kelly · « **on:** December 10, 2014, 06:54:28 am »

Hey All! I just wanted to let you know that I took my son to the Liver Wellness Center in Little Rock, Arkansas yesterday and I am in awe! A little background info for ya.....My son, 21 years of age, was diagnosed back in August with Hep C. He had joined the Air Force and that's when it was discovered. He was discharged and sent home. When he got home, I made an appointment with a gastro doctor, who I thought at first was very kind and compassionate and wanted nothing more than to get him well. He told us about Harvoni and that he wanted to wait until the drug became available to treat him. Well, we waited only to be denied by Express Scripts. We have United Healthcare insurance. I read on the forums where people had filed appeals and were eventually awarded Harvoni so I asked him to file an appeal, which he said he would NOT and wanted to prescribe interferon, etc. I was desperate at that point and started looking for a new doctor. Low and behold, we found the Liver clinic. We went in there and the doctor was absolutely shocked at how he was treated prior and said that United Healthcare doesn't even use Express Scripts!! We go through OptimumRX, and they are APPROVING harvoni right and left for folks. She said he will be receiving his meds within a week and will be on a 12 week regimen!! Just wanted to let anyone know who has United Healthcare that your doctor may be going down the wrong avenue with prior authorizations. Anyone else have this issue?

apache · « **Reply #1 on:** December 10, 2014, 01:46:59 pm »

Hi Kelly,
Congrats on getting Harvoni approved! That's quite an accomplishment.

My understanding is that the reason so many of us who have United HealthCare insurance have been denied Harvoni is because... UHC changed their policy recently and only approve it for those who have a fibrosis score of F3, Fibroscan of 9.5 or worse, and a few other criteria. The complete list of UHC criteria is listed here:

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Harvoni_Medical_Necessity.PDF

Q#1: do you know if your son met any of those criteria (F3 or worse, etc)? Or was it more of a case that your dr just knew how to use the correct convincing verbiage in his Harvoni request to OptimumRx?

In the meantime, I'll contact my dr. to ask him to try going through OptimumRx.

Q#2: if you don't mind my asking, what is the phone number for your doctor at "The Liver Clinic"? I wanted to pass along that info to my dr., as perhaps he can use the same convincing verbiage that your dr used in his Harvoni request. (Note: I tried googling "The Liver Clinic", but got lots of hits...)

Bucky · « **Reply #2 on:** December 10, 2014, 03:00:46 pm »

Quote from: Kelly on December 10, 2014, 06:54:28 am

Hey All! I just wanted to let you know that I took my son to the Liver Wellness Center in Little Rock, Arkansas yesterday and I am in awe! A little background info for ya.....My son, 21 years of age, was diagnosed back in August with Hep C. He had joined the Air Force and that's when it was discovered. He was discharged and sent home. When he got home, I made an appointment with a gastro doctor, who I thought at first was very kind and compassionate and wanted nothing more than to get him well. He told us about Harvoni and that he wanted to wait until the drug became available to treat him. Well, we waited only to be denied by Express Scripts. We have United Healthcare insurance. I read on the forums where people had filed appeals and were eventually awarded Harvoni so I asked him to file an appeal, which he said he would NOT and wanted to prescribe interferon, etc. I was desperate at that point and started looking for a new doctor. Low and behold, we found the Liver clinic. We went in there and the doctor was absolutely shocked at how he was treated prior and said that United Healthcare doesn't even use Express Scripts!! We go through OptimumRX, and they are APPROVING harvoni right and left for folks. She said he will be receiving his meds within a week and will be on a 12 week regimen!! Just wanted to let anyone know who has United Healthcare that your doctor may be going down the wrong avenue with prior authorizations. Anyone else have this issue?

Hello Kelly,
I am so glad that your son is apparently going to the meds he needs. So much went wrong here but it sounds like you prevailed. Did your son get through Basic Training or was he discharged right away? Also, I am shocked that the doctor applied to the wrong insurance provider. I would say that his office staff made the mistake but a mistake was made just the same. And to then suggest Interferon, I would have high tailed it out of there as well and found another doctor.
Thanks for posting about United Healthcare / OptimumRX. You have likely saved someone else the frustration that you endured.
Your forum name should be "Mama Bear", way to go protecting your cub.
Bucky

kelly · « **Reply #3 on:** December 10, 2014, 03:36:12 pm »

Lol. Thanks Bucky! Actually I may have posted way too soon. I called optum Rx today and they don't have myvaon in their system. They told me that they cover my husband's prescriptions but since we are under his plan then express scripts is who handles ours. The doctor we saw yesterday was adamant it was optum and said that's who she would file it through. I'm back to being confused. Ii had a busy day at work and hadn't got to call express scripts yet. Zack is genotype 1 with no fibrosis and a 17 million viral load right now. He joined the air force and was in his second week when they blood work came back showing anemia. After more tests and six weeks later, hep c was our diagnosis as well as separation. Broke him down bad!!!! We are here to slay this dragon along with everyone and will fight fight! Yes.. I'm a momma bear for sure and am looking straight ahead for the cure!

apache · « **Reply #4 on:** December 10, 2014, 06:32:58 pm »

Quote

In the meantime, I'll contact my dr. to ask him to try going through OptimumRx.

Update: my dr's office said that they actually did try OptimumRx, and with my insurance (UHC) were denied, as I don't meet the F3, etc hurdle.

kelly · « **Reply #5 on:** December 10, 2014, 08:52:15 pm »

Really??!!! Are you filing an appeal?

kelly · « **Reply #6 on:** December 10, 2014, 08:53:38 pm »

Don't give up. Get two denials and go to mysupportpath.com.

apache · « **Reply #7 on:** December 10, 2014, 10:13:32 pm »

Quote

Don't give up. Get two denials and go to mysupportpath.com.

Actually... I've tried calling MySupportPath every day this week (Mon, Tues, Wed), but they aren't answering the phone. And aren't responding when I leave my phone number for a call back.

With all the monopoly profits Gilead is raking in from Harvoni, they can afford to hire a few more support staff (for MySupportPath) to answer the phones, if they so desired.

So I suspect something else is going on. It appears that Gilead/MySupportPath is playing a waiting game, stalling until they see how AbbVie prices their 3D Rx, assuming 3D gets approved when the FDA renders their verdict (later this month).

If 3D is approved, AbbVie can go one of two ways: a) OPEC model - meaning Gilead and AbbVie decide to stick together and both charge ridiculously high prices (in the US), or b) competitive model - meaning AbbVie, seeing all the negative press Gilead is getting, decides to offer their Rx for a much more reasonable price, thereby selling a lot more (quantity) in the US, which will eventually translate to larger profits than charging such high prices that very few can afford to actually buy it. Which in turn will force Gilead to lower their prices.

Under outcome (b), I could see UHC (and other insurance companies) finally agreeing to "permit" their customers access to Harvoni (and 3D). Under outcome (a), I suspect that those of us fortunate enough to have livers which haven't reached the F3 stage will continue to be left out in the cold. Unless they are "lucky" enough to meet the < $100k combined household income threshold.

I would love to be proven wrong on this, but in all my googling I have yet to find any stories of anyone < F3 getting Harvoni via MySupportPath, unless their family met the < $100k household threshold.

kelly · « **Reply #8 on:** December 11, 2014, 06:07:53 am »

Apache, you are so right. I've done a lot of research as well and don't see anyone getting it <F3. It's really a shame as I would think insurance companies would want to prevent this virus from causing more damage before it happens rather than later as to cut medical costs. I got a call yesterday from another pharmacy named Arious (not sure if that's the correct spelling) and they said they are working on prior authorization for us as well. I told them that I have someone at Express Scripts helping as well and that I have to go through them. They informed me that they were calling United Healthcare and would get back with me today. Also said they had gotten approval for others on united healthcare and that Express Scripts is kind of their "competitor" I'm sure confused on all of it. I guess I dont care who is helping as long as we get it. Hopefully AbbieV will be released soon and there will be better chances. Hang in there!!

kelly · « **Reply #9 on:** December 11, 2014, 06:10:02 am »

Sorry, Apache, missed the other question. The number is 501-687-9300. Ask for Joy or Shaniqua.

gea · « **Reply #10 on:** December 11, 2014, 07:49:11 am »

Kelly
I cannot imagine fighting this fight for my child. You must feel so frustrated. It's one thing for us to handle, but a totally different experience, I'm sure, to watch your child go thru it....

I am REALLY not sure how the whole prescription angle works, but my insurance is also thru Express Scripts for regular medications... HOWEVER, when my GI doctor prescribed Harvoni for me, it came thru Specialty Pharmacy, which is actual Giant Eagle's company (they are the huge grocery chain in this area).....

So, does it depend on where the prescribing doctor deals with?

Just trying to be helpful as one Mom to another. Wishing you and your son good luck!

kelly · « **Reply #11 on:** December 11, 2014, 08:00:01 am »

Gea, thank you for you response. Yes, it is very hard. Especially when I don't think he quite gets the whole concept of what he is dealing with. Although he's 21, he just doesn't get the fact that this is horrible for him. It is devastating to me but I'm not quitting until he gets the new meds. I refuse to put him on intereron. We are having to use a speciality pharmacy and that's actually Acreedo. Express Scripts evidently has to do the prior authorization and then Acreedo fills it. However, this new pharmacy that called me yesterday said they have dealt with our GI doctor LOTS and they know she is adamant in her patient care and that they are trying to get information gathered and a preauthorization done because they knew the doc would be calling to check on it regularly. I'm assuming it is all in who the doctor deals with....but, again, this is all so new to me and I am clueless as to how it works. I just want the MEDS!!! I don't care who fills it. LOL Thank you, again. I wish you luck as well in fighting the fight!

kelly · « **Reply #12 on:** December 11, 2014, 09:55:16 am »

JUST GOT A CALL FROM OUR DOCTOR AND WE ARE APPROVED FOR HARVONI!! She got it done through Acreedo! I absolutely cannot believe it. Should be receiving meds on Monday or Tuesday she said. Waiting for the call from Acreedo to set up delivery! Fighting the Fight!!

gea · « **Reply #13 on:** December 11, 2014, 10:56:02 am »

Kelly !!!!

Yipppppeeeeeee ! The big peachy pill will soon be there for you and your son!
Merry Christmas! Best gift you could ask for, right Mom?

kelly · « **Reply #14 on:** December 11, 2014, 11:15:05 am »

For sure gea!! Merry Christmas!

badbradley · « **Reply #15 on:** December 11, 2014, 11:19:15 am »

Good for you Kelly! Your son is very fortunate to have a Mom like you! Starting another day with a smile on my face! Best wishes to Zack on his treatment.
Brad

kelly · « **Reply #16 on:** December 11, 2014, 11:27:23 am »

awww, thanks Brad....brother from another mother!! Yes, I'm smiling today as well

apache · « **Reply #17 on:** December 11, 2014, 12:48:28 pm »

Hi Kelly,

Quote

JUST GOT A CALL FROM OUR DOCTOR AND WE ARE APPROVED FOR HARVONI!! She got it done through Acreedo! I absolutely cannot believe it.

Congrats on getting the Harvoni approved!!

Quote

The number is 501-687-9300. Ask for Joy or Shaniqua.

Thanks for the phone number!

One last question, are there multiple providers at that location? If so, who is the actual provider who submitted the Harvoni request for you? When my liver specialist (Dr. Kalle Kang, Bellevue Gastroenterology) calls Joy/Shaniqua, I just want to make sure that Joy/Shaniqua connect Dr. Kang to the correct provider at The Liver Clinic. The one who was able to get the Harvoni request approved. I tried googling but came up with multiple provider names. Lynn Frazier is the only female name. Is that the correct person?

Thanks in advance.

kelly · « **Reply #18 on:** December 11, 2014, 12:52:29 pm »

Apache, yes it is Lynn Frazier. Good luck with it and let me know how it goes for you!!

BattleTheBeast · « **Reply #19 on:** December 11, 2014, 12:53:08 pm »

Hi Kelly!

HOORAY!!!

Hope his treatment is smooth and the end result is the cure. He's lucky to have such a great Mom....

Mel

kelly · « **Reply #20 on:** December 11, 2014, 12:54:20 pm »

Thanks, Mel!! Makes me smile even more!!

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Author Topic: United Health Care and Harvoni (Read 31770 times)