Insurance approval

[Ladydi111]

 My partner is having a very hard time getting harvoni approved with United healthcare.. They keep giving him the run around!  They say that they don't get the documents from the doctor, but he speaks to them directly at the doctors office. We can't tell if the insurance is dragging there feet....
 
 Any advice or experience is appreciated.

[Lynn K]

Many have had similar experiences unfortunately just keep calling and calling

Good luck

[apache]

Lynn is correct.

But I also wanted to add that... not all UHC policies are the same:  if you get UHC through your employer, then your employer specifies which Rx's are and are-not covered under your "flavor" of UHC insurance policy.   

For example, I have UHC.  I called them right after the Wall St. announcement that UHC had selected Harvoni (rather than Viekira) as their Hep C Rx of choice .  The UHC rep told me that Harvoni was a plan exclusion.  When I asked about the Wall St. article, she said, "yes, UHC covers Harvoni, but your company's UHC policy does not."    She then gave me a complicated document name, and suggested I follow up through my company's HR department, asking them to include Harvoni in "our" UHC policy, going forward.

Good luck.

[coloradogirl]

I would keep checking the drug formulary for your plan, which is the list of approved drugs.   The drugs are so new, it might be the insurance company, pharmacy they use,  and the drug company had not settled contract negotiations yet.
I expected to pay $250 per month for the Speciality drug price, so I was surprised to learn I would only be paying $60 for a 4 week supply of Harvoni.   

 

[apache]

Hi Coloradogirl,

Indeed, you are 100% correct:

I would keep checking the drug formulary for your plan, which is the list of approved drugs.   The drugs are so new, it might be the insurance company, pharmacy they use,  and the drug company had not settled contract negotiations yet.

I had to go through three levels of HR at my company (which took several weeks), but by the time my case reached someone who had a clue, my company's UHC policy had been updated... and it now covers Harvoni (8 weeks).   So, a happy ending - assuming of course that the Harvoni works

Interestingly, while I was looking at my company's HR org chart, it turns out that there are 108 employees in our HR department, of which 106 are temporary contractors.   In other words, only 2 of the 108 people in HR are permanent employees.  And it was one of those 2 who was able to track down the list of what is/is-not allowed on our company's UHC Rx inclusion list.  And he's the one who discovered that Harvoni had (a few days ago) been added to our UHC policy.

[Ladydi111]

He just was told today that he isn't sick enough! 

[Ladydi111]

I would keep checking the drug formulary for your plan, which is the list of approved drugs.   The drugs are so new, it might be the insurance company, pharmacy they use,  and the drug company had not settled contract negotiations yet.
I expected to pay $250 per month for the Speciality drug price, so I was surprised to learn I would only be paying $60 for a 4 week supply of Harvoni.

It has been approved, United health care said he isn't sick enough, his platelets are so low, and feels sick everyday. Who's your insurer? How hard was it for you?  He has been rejected four times

[BubbaT]

Hi ladyDid,

Are you aware of gilead support path!

After 2 denials, gilead will help you get the meds!

Call 1-855-769-7284 and speak with them and see what options are available

Also if your husband is f3-f4 they will approve him.   I have uhc / Caremark
They approved me after dr sent them my results @ f4 ,
Has your husband had a recent ct scan or fibro sure ?

Keep fighting for your husband, we support you!

God bless!

[Ladydi111]

Hi ladyDid,

Are you aware of gilead support path!

After 2 denials, gilead will help you get the meds!

Call 1-855-769-7284 and speak with them and see what options are available

Also if your husband is f3-f4 they will approve him.   I have uhc / Caremark
They approved me after dr sent them my results @ f4 ,
Has your husband had a recent ct scan or fibro sure ?

Keep fighting for your husband, we support you!

God bless!


We have spoken to support path countless hours on the phone, they keep putting us off that is why we keep trying to get insurance to cover it.. I'm not sure what else to do now

[coloradogirl]

It has been approved, United health care said he isn't sick enough, his platelets are so low, and feels sick everyday. Who's your insurer? How hard was it for you?  He has been rejected four times

Ladyi111,

My platelets are normal, but I am getting treatment. So that doesn't have much baring. What REALLY concerns me, is if his platelets are low, did they check for Hepatitis B or some other infection like sepsis, or even ITP?  Is he jaundiced? If you scratch his skin with a fingernail, does it leave a lasting mark?  I almost lost my husband last year from a bacterial infection that dropped his platelets to 11,000. He was susceptible because he doesn't have a spleen. And he doesn't have a spleen because of ITP when he was 12. Alcoholics are also susceptible to sepsis. There is something going on that needs further investigation, for sure.

What kind of doctor does he have, and what tests were performed? Did he have a Fibroscan done? What are his ALT and AST numbers? What is his viral load?  If all of those aren't there, you better get another doctor.

I hope you get this resolved. And get copies of all the tests that were done, too, while you are at it.

I am praying that his situation will be addressed. I wish I had seen this post sooner, because low platelet count isn't something to mess with.

[Lynn K]

How low are his plateletts? Before I was treating mine are normally about 85 with min normal 150. Mine are low due to cirrhosis from hep c

[Ladydi111]

Update he was approved starts Tuesday!

[coloradogirl]

Good news indeed!