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Author Topic: Is insurance the decision maker or pharmacy?  (Read 6154 times)

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Offline BubbaT

  • Member
  • Posts: 267
Is insurance the decision maker or pharmacy?
« on: February 28, 2015, 03:49:15 pm »
hi everybody, can someone tell me who determines whether or not you get approved for treatment?

Does the insurance company have the final say on who gets treated or does the pharmacy make the decision?

I'm confused, can someone help me understand?

Thanks,   I am waiting on approval now and would like to know what is holding up the approval, since I'm f4 and never treated I would kind of like to get on with the treatment, know what I mean? I have united healthcare and Caremark .

Tested pos in 95, hep c 1a,
I waited this long for harvoni, now I understand I can get the meds even after denied by Insurace if I make less than 100k? So I got that part cleared, I'm having frustration because of delay.  I'm 57 now. I have been fighting the virus through healthy lifestyle, milk thistle, and other supplements, prayer.

I'm a fighter, I refuse to give up...
Thanks for your helpful advice, I like having your support and am very thankful for this site.

Age 57 male
Infected late 70's
Diagnosed 95
1a, 2 prev biopsy 95, 2004
Ct 2007, 2015
Treatment Naive
F4 A3. Fibrosure/ CT 2-5-15. Ammonia 222
VL 2.2 mil.
Started Harvoni  3-3-15. 12weeks, finished 5-26-15
4 week VL undetected
12 week EOT undetected

Offline Sam1224

  • Member
  • Posts: 62
Re: Is insurance the decision maker or pharmacy?
« Reply #1 on: February 28, 2015, 09:08:25 pm »
It's the insurance company.

Offline Junkyard

  • Member
  • Posts: 24
Re: Is insurance the decision maker or pharmacy?
« Reply #2 on: February 28, 2015, 10:16:33 pm »
The insurance company decides if they pay for the medicine. Your dr decides if you need it. You can buy anything your dr prescribes if you have the money.   What the insurance pays for is the obvious question.  The prequalify cation for most insurance is important. Make sure the insurance company has all your info such as viral load biopsy etc.  your dr should submit that to the insurance company. 
Support path is the help line that Gilead has set up. You have a form you can get at support path.com. They have certain qualifications to get their help.
Do your research before you get started and you will have the answers if the insurance denies your coverage.
Everyone here needs to know "if it is to be it will be me". Know what your insurance covers and what the help is for plan "b". Then have plan "c" available.. Whatever they may be. Just be prepared before your get started so you can appeal any denials.
Goodluck

Offline BubbaT

  • Member
  • Posts: 267
Good news I got approved! Yea!
« Reply #3 on: February 28, 2015, 10:40:28 pm »
Thank you,   :D

I have good news, I got approved praise the lord.   I should get the Harvoni meds this week! YEA!   I have waited for 20 years to get treated for this dreadful virus, I am hopeful like you are to be free from this devil, a heartfelt thank you Lord and hope for All of your recovery also, I know many of you are suffering and I ask God to help you get cured anyway possible, also I want to say thanks to all the friendly and caring people who post here, I will follow up with hope and anticipation to be free again, oh how I long to be well again My friends in this struggle against hcv.
 
Age 57 male
Infected late 70's
Diagnosed 95
1a, 2 prev biopsy 95, 2004
Ct 2007, 2015
Treatment Naive
F4 A3. Fibrosure/ CT 2-5-15. Ammonia 222
VL 2.2 mil.
Started Harvoni  3-3-15. 12weeks, finished 5-26-15
4 week VL undetected
12 week EOT undetected

 


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