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Author Topic: Satisfaction at last!  (Read 8359 times)

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Offline C-FIGHTER

  • Member
  • Posts: 43
Satisfaction at last!
« on: March 13, 2015, 04:12:45 pm »
Hello

After two denials by my pharmacy manager, Prime Therapeutics, through BCBSIL, the decision was overturned by Medical Reviews of America. I could not believe by eyes when I read this through a message sent by my Dr. office on My Chart. with my fibrosis score less than F1, I was not deemed sick enough to get the medicine needed to slay this ugly fire breathing dragon.  Please have hope and fight for the meds so badly needed to eradicate this horrible disease.  You will get it, if I can do it anyone can. Blue Cross, pay the bill!  I got the $5 copay.
diagnosed 2010 Hep C
genotype 1b
HCV RNA >4000000 01/13/2015
F0-F1 04/2014
Harvoni March 20 2015 - June 11 - 12 weeks

April 14-Day 26 on Harvoni- Viral Load - UD
ALT 27    AST 27

Offline skycatcher

  • Member
  • Posts: 64
Re: Satisfaction at last!
« Reply #1 on: March 13, 2015, 04:36:15 pm »
Congates!  I have BCBS and they have just been great. Too bad you had problems with them.  I started last week on Harvoni and everything has been smooth.  My fibrosis score is very low also along with all the other numbers.  And to date no side effects from Harvoni.  Staying hydrated IS the biggest and most important thing to do I believe. I place a bottle of water on the night stand and first thing in the AM I drink it then take the magic pill.  No headaches.

Congratulations again! Here's to a future being HCV free.

   ~    Skycatcher

Offline pl1952

  • Member
  • Posts: 24
Re: Satisfaction at last!
« Reply #2 on: March 13, 2015, 04:42:32 pm »
Good for you C-Fighter!  I wish you smooth sailing on this treatment.  Today is day 8 on Harvoni, and no symptoms and I feel great!
GT 1b
Treatment naive
2/2014:  Fibroscan 4.5
12/2014:  VL:  650,000
Started Harvoni 3/6/15
EOT: 5-28-15
9-2015:  SVR 12

Offline C-FIGHTER

  • Member
  • Posts: 43
Re: Satisfaction at last!
« Reply #3 on: March 13, 2015, 08:07:01 pm »
Sky Catcher,

thank you for your Congratulations!  I feel the problem was more with the pharmacy manager, Prime Therapeutics.  They are the ones who denied me twice. Blue Cross/BS Uses PT as their specialty med distributor. So I believe it is all one entity at the end of the day. That being said everyone was nice, it's all about corporate really. The medicine costs too much for many people to afford, even if the income of the house is 100,000. I feel for all of those who continue to suffer, but believe if you continue the fight, you will have your day in court.

 Congratulations to you also and I wish you Godspeed with SVR. :-)
diagnosed 2010 Hep C
genotype 1b
HCV RNA >4000000 01/13/2015
F0-F1 04/2014
Harvoni March 20 2015 - June 11 - 12 weeks

April 14-Day 26 on Harvoni- Viral Load - UD
ALT 27    AST 27

Offline skycatcher

  • Member
  • Posts: 64
Re: Satisfaction at last!
« Reply #4 on: March 16, 2015, 04:48:10 pm »
And to you to C-Fighter!

Over the many years I have read of so many struggles with insurance cos.  it is  sad indeed. But , hey, here we are.....
    ~   Skycatcher
 

Offline C-FIGHTER

  • Member
  • Posts: 43
Re: Satisfaction at last!
« Reply #5 on: March 17, 2015, 07:20:00 am »
Sky Catcher,

I think if we all hang in there and continue to fight, we will all get the meds we need.  I just got a copy of my review from the medical review board in the mail.  The reasons i was denied by insurance were:  I did not have cancer, I did not have HIV, I did not have cirrhosis, my score was 5.9, and not 7.85.  I do have something showing PBC ( primary billlary cirrhosis) and we did discuss this when i was at the Dr.office.  However my doctor does not believe that i truly have this.  After i clear the virus more tests will be done on this.  I hope he is right and i do not have this.  If  i do as a result of the HEP c, it hopefully will clear my system as well when i am on Harvoni.

What time do you take the Harvoni?  I will have mine Friday and thinking which might be the best time.
C-fighter
diagnosed 2010 Hep C
genotype 1b
HCV RNA >4000000 01/13/2015
F0-F1 04/2014
Harvoni March 20 2015 - June 11 - 12 weeks

April 14-Day 26 on Harvoni- Viral Load - UD
ALT 27    AST 27

Offline C-FIGHTER

  • Member
  • Posts: 43
Re: Satisfaction at last!
« Reply #6 on: March 17, 2015, 07:21:16 am »
i believe it was the PBC that swayed the medical board, forgot to mention in the previous post.

C-fighter
diagnosed 2010 Hep C
genotype 1b
HCV RNA >4000000 01/13/2015
F0-F1 04/2014
Harvoni March 20 2015 - June 11 - 12 weeks

April 14-Day 26 on Harvoni- Viral Load - UD
ALT 27    AST 27

Offline skycatcher

  • Member
  • Posts: 64
Re: Satisfaction at last!
« Reply #7 on: March 17, 2015, 04:31:47 pm »
Hey C-FIGHTER.
That really bites that that would be the basis for denial. I am really happy for you that things are now moving in a positive direction. I guess if I had to go through that board I would not be "sick" enough either.  I would be doing just what you have been doing.  Being persistent. AND being ever present.

My Harvoni was delivered on Wednesday afternoon and I started my med on Thursday AM March 5th.  Same time everyday. For me I have picked 9:15 as the magic moment. I don't like even numbers when dealing with time so I decided for me this is the best time.  It's not too early in the event I can't sleep well. I set my clock for a few minutes before and wake up and drink most of a bottle of water and take my very expensive magic pill. The first few days I did eat a piece of toast shortly after -- the last few days I haven't done that-- but I am starting back doing the toast and water thing tomorrow morning.

I have noticed that eating breakfast relatively soon after drinking my first cup of coffee is important as well. (I drink 2 cups a day)
Today I got busy and didn't eat right away and started developing a pretty bad headache.  I think it is a combo of things some of which I did incorrectly this morning.  Did not drink water #2 after coffee #1.  Instead drink 2nd cup of java and put off food. I finally ate but it ended up being 3 hours after I got up and going. The other things are out of my control: weather front coming through right now. Spring is doing what it does best and green things are beginning to bloom (wild things like the wild plum trees). And of course setting the pollen free...
So such is life...

So I will say pick your magic moment and set it in gold. Same time same place.  Just to make sure I haven't run out of anything I got extra juices and a extra case of water.  I am not going to run out of anything so I can't panic over that. I'll have to find something else ... ;)

Yours in Health    ~   Skycatcher


Profound fatigue led to 1993 diagnosed non A/non B   HCV
Looked into treatment/trails 2000 did not pursuit. Genotype 1a  Viral count 32521.
Yearly blood work --OK Slight enzyme elevation. ALT 1-6 pts.
2015 ultrasound slight echogenicity  HCV 929,000
AKL PHOS--116 / AST--55 / ALT--78   Fibrosis Stage F0    Activity Grade A1-A2
Treatment naïve.  Started Harvoni March 5th 2015.  So far so good!

 


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