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Author Topic: United Health Care and Harvoni  (Read 34555 times)

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Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
United Health Care and Harvoni
« on: March 17, 2015, 04:35:22 pm »
Hello friends
I have been doing a lot of reading here and I would like you to please post if you have received Harvoni through United Health Care insurance
My UHC specialty pharmacy is OptimRX
I know that preauthorization is required and I did find 2 links showing their guidelines.  (I searched through my UHC account site and didn't find these anywhere)  The newest guidlines are a lot tougher so I am anticipating that I will not be able to get Harvoni but I sure as hell will try.
Anyway I would appreciate it if you can post here if you finally got Harvoni though your Untied Health Care Insurance.  I have a PPO plan so "technically" it is suppose to be a better plan.  I have not had any issues with them all these years and they cover most everything.
Thanks :)   
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #1 on: March 17, 2015, 05:27:27 pm »
Hi Debula,
I have United Healthcare.  If I login to MyUHC it says I have 'Choice Plus' plan.
My first denial from UHC was immediate because at the time Harvoni was plan excluded and they were offering Sovaldi + Olyssio.  My doctor appealed because I have Sulfa allergy and cannot take Olyssio.  Second denial came back 'not medically necessary'.  Their letter said to check back in a couple of years when my condition has worsened.  A week or two later I found out Harvoni was no longer plan excluded and UHC rep told me to have doctor resubmit the prior authorization.  Denied again because they said it was a duplicate request.  UHC representatives do not understand their own procedures and caused a lot of wasted time and effort.   I appealed to NC Dept of Ins. Their decision is considered final and I am not permitted to appeal.  They upheld UHC decision.  Gilead rep told me to apply for an exception to their patient assistance program even though we are slighly over their 100k gross income level.  Denied... rep told me they rarely approve these exception requests.  I don't know why they suggested I waste my time.  The only help they offer is their standard co-pay coupon. I have spent 3 months having all of this paperwork submitted over and over, and waiting weeks at a time for their decisions.   It has been a complete waste of time and effort. UHC and Gilead do not care about the people they serve.  Praying you have better luck.

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #2 on: March 17, 2015, 06:38:33 pm »
Hi friends,

I have united healthcare, and was approved after one denial, after the denial,
I complained of mental fog, and he ran an ammonia test on me and It came back above normal 222' so he rx Xifanan and lactiluose, prior to submitting appeal,
My Gi had a fibrosure test and had a ct done and it came back f4, so I got the pills.

I would suggest you complain of symptoms to your Dr. And let him know you are having more severe effects from the hep c, and ask him for more testing,the insurance people are going to stonewall you unless you raise he// and tell Em to get of their arse,  and give you the meds you need, also call your congressmen and senators and tell them your story, I read where one poster had called the local media to do a story on the insurance company and they suddenly decided to give her the meds!

So fight for your right to get well, I'm with you!

« Last Edit: March 19, 2015, 12:02:11 pm by BubbaT »
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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #3 on: March 17, 2015, 08:41:49 pm »
Thank you both for your replies.  At least now I know what to expect.
Slw304 I don't know what to say.  There has got to be something you can do.  This is an outrage!
Good luck to both of you
I will keep you posted on my progress.  I am verrrrrrrry stubborn but I don't know how hard my doc will fight for me. 
UHC and any other insurance that wont cover it should be ashamed!
This is the country we live in  >:(
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #4 on: March 18, 2015, 10:24:49 am »
I just found this article that looks promising!
Quote
Jan 28 (Reuters) - UnitedHealth Group Inc, the largest U.S. health insurer, on Wednesday backed Gilead Sciences Inc's Harvoni as the preferred hepatitis C treatment on its 2015 commercial drug coverage list, another victory for Gilead over competitor AbbVie Inc.
http://www.reuters.com/article/2015/01/28/unitedhealth-gilead-hepatitisc-idUSL1N0V72OS20150128http://www.reuters.com/article/2015/01/28/unitedhealth-gilead-hepatitisc-idUSL1N0V72OS20150128

« Last Edit: March 18, 2015, 10:27:20 am by Debula »
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline pl1952

  • Member
  • Posts: 24
Re: United Health Care and Harvoni
« Reply #5 on: March 18, 2015, 07:37:23 pm »
Hi Debula, I have UCH PPO too and was denied twice.  Same as slw, basically not sick enough, come back in a couple of years. .just outrageous....I also saw that link  you posted and had a sliver of hope but it didn't matter.  I'm 2 weeks on Harvoni thanks to Gilead Support Path...
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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #6 on: March 19, 2015, 09:50:20 am »
Hi Debula, I have UCH PPO too and was denied twice.  Same as slw, basically not sick enough, come back in a couple of years. .just outrageous....I also saw that link  you posted and had a sliver of hope but it didn't matter.  I'm 2 weeks on Harvoni thanks to Gilead Support Path...
Thanks for your input
How long did it take for you to get approved by Gilead support path? 
How many appeals did you have to submit to UHC in order to qualify for Gilead Support path?
 I am happy that you are finally on Harvoni!
Good luck to you and keep us posted
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline pl1952

  • Member
  • Posts: 24
Re: United Health Care and Harvoni
« Reply #7 on: March 19, 2015, 09:57:57 am »
Hi Debula, it was pretty fast.  Someone posted directions on what they did, step by step...I followed that exactly and got all my papers together.  My doctor's office was working with Acaria Pharmacy who I'm assuming was hired to deal with all the denials the Doctor's office has been getting.  I sent Acaria all the info, they in turn forwarded it on to Supporth Path.  It was under a week.  I'll see if I can find that link for you.
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 slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #8 on: March 19, 2015, 10:03:59 am »
Debula, Support path requires that you submit your prior authorization denial letter along with your appeal denial letter.  To qualify for their assistance your gross household income has to be less than 100k.  This was not my situation so I can only receive the value of the copay coupon which turned out to be 25k.  My suggestion to you is if your liver status is less than F3 then have your support path papers ready to go so that you can fax them directly after you receive the UHC denial to your appeal. I did submit an appeal to support path.  It took them 2 weeks to get confirmation on insurance information from UHC then called me with a denial about 3 days after that.
If you fall under their income threshold then you should not have a problem.  If you are over then you need to start researching other options.  Good luck!

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #9 on: March 23, 2015, 04:29:20 pm »
I don't know if this means that something might have changed but
this is directly from UHC website dated Feb 2,2015
http://broker.uhc.com/articleView-14843

Quote
Two hepatitis C medications, Harvoni® and Viekira Pak® were recently approved by the US Food and Drug Administration (FDA).  Both medications are highly effective when used in patients with appropriate genotypes.  Both have very acceptable adverse event profiles.  However, both are very costly.  To assure access to these and other hepatitis C medications within an affordable pharmacy benefit,   we are pleased to announce our Prescription Drug List (PDL) decisions that will result in no negative member impact upon the Feb. 1, 2015, implementation.

While prior authorization (and medical necessity if applicable) has been in effect since the launch of these medications to ensure appropriate coverage review and utilization, the following changes will take effect on Feb. 1, 2015, and July 1, 2015.

Feb. 1, 2015 (existing users grandfathered)
•Harvoni will be down-tiered to Tier 2
•Sovaldi will be down-tiered to Tier 2
•Step therapy applied to Olysio, Victrelis, Viekira Pak (Step 1: Harvoni)
•Step therapy applied to Sovaldi only for genotype 1 (Step 1: Harvoni)

 July 1, 2015 (Jan. 1, 2016 for those on Traditional PDL)
•Olysio will be up-tiered to Tier 3 (Tier 4 as applicable)

We are happy to offer two Tier 2 options to cover all spectrums of the hepatitis C genotypes. Harvoni, the most prescribed drug because of its convenience, high effective rates and minimal side effects, will be an affordable option for members.

View a summary of all of the hepatitis C PDL decisions.

If you have any questions on hepatitis C or PDL changes, please contact your UnitedHealthcare representative
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #10 on: March 23, 2015, 10:50:35 pm »
Under my UHC plan sovaldi + olyssio was the preferred drug and harvoni was plan excluded. On February 1 harvoni was changed to the uhc drug of choice however their criteria for approval did not change.  Hopefully your plan is different but the plan i am under still requires f3 liver biopsy to qualify for treatment coverage.  You still haven't received word from uhc?

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #11 on: March 24, 2015, 01:51:50 pm »
Under my UHC plan sovaldi + olyssio was the preferred drug and harvoni was plan excluded. On February 1 harvoni was changed to the uhc drug of choice however their criteria for approval did not change.  Hopefully your plan is different but the plan i am under still requires f3 liver biopsy to qualify for treatment coverage.  You still haven't received word from uhc?
Well darn!   >:(   anyway I go to my doc on Friday and we will take it from there.  All of this is just preliminary research on my part.  I am still waiting for my genotype (that I will find out on Friday) and I guess I will need a fibroscan or biopsy :(
I was hoping this was new info and that the criteria might have changed too
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #12 on: March 24, 2015, 02:36:59 pm »
Unfortunately, I don't think so.  The UHC customer service reps actually thought the same thing.  They told me to have the doctor resubmit the prior authorization request because they thought it would be approved since the drug was no longer an exclusion.  The prior authorization request was resubmitted, but nothing had changed. UHC still denied coverage saying it was a duplicate request.  Prepare for a run-around from UHC.  Their reps don't understand their own policies and UHC is going to do anything possible to deny your claim - unless your liver biopsy comes back F3 or greater.  I prayed for healthy liver results but now I think a higher fibrosis score might have been better.

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #13 on: March 25, 2015, 03:15:21 pm »
Thanks slw304.  What date did you resubmit?  I read on another forum that somebody got denied and then the pharmacy called and told them they were approved. That UHC had reversed their decision and they didn't even tell her!  the pharmacy did.  ( It was UHC but through medicare or something so that might different? not sure)
Anyway.. I will keep you posted on my progress once we submit.  I see the doc on Friday.
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #14 on: March 25, 2015, 10:42:21 pm »
I spent 6 full weeks beginning mid-January going back and forth with United Health Care appeals and denials.  Thanks for the information Debula.  I will definitely give them a call tomorrow to verify nothing has changed.  I'll also be saying prayers that your dr. visit goes well for you and that you get all the information you need.  For me, the doctor visits and lab stuff weren't too bad.  The biggest stress came from United Healthcare.  Hopefully you'll have a better idea of what to expect and save yourself some aggravation. 

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #15 on: March 26, 2015, 11:07:40 am »
slw I am glad you are going to call them.  Even if things are still difficult maybe you can resubmit and not get rejected this time (I want to be hopeful)
I am so glad I found this forum because yes I am prepared now.
I was thinking it would be easy once I was prescribed and now I know I will have a battle to deal with.  I take some comfort knowing that I do meet the income guidelines and if all else fails I can to Gilead for help.  What a hassle to get well!  I wish you luck and I hope they approve you finally.   Keep us posted please
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline Vintag54

  • Member
  • Posts: 22
Re: United Health Care and Harvoni
« Reply #16 on: March 30, 2015, 11:47:47 pm »
I have UHC a and was denied Harvoni that was excluded from their supported list. After two attempt bothe denied, I was approved for Olysio and Solvaldi combo treatment that is going very well. I was told if this treatment does not work for me that I would be approved for Harvoni but need to try Olysio/Solvaldi first.

Not a pleasant experience at all, but patience paid off. Both Olysio and Solvaldi have $5 co-pays programs so I end up paying $10 per month for both drugs. And that's it.

Good luck!

Bob
Warm Thanks, Vintag54

HCV over 30 yrs.
64 yrs
Genotype 1a
Viral load in orbit.
3.5 mos of interferon/rabavirin
2/5/2015 on Sovaldi/Olysio

Offline dragonslayer

  • Member
  • Posts: 873
Re: United Health Care and Harvoni
« Reply #17 on: March 31, 2015, 09:18:59 am »
I have UHC a and was denied Harvoni that was excluded from their supported list. After two attempt bothe denied, I was approved for Olysio and Solvaldi combo treatment that is going very well. I was told if this treatment does not work for me that I would be approved for Harvoni but need to try Olysio/Solvaldi first.

Not a pleasant experience at all, but patience paid off. Both Olysio and Solvaldi have $5 co-pays programs so I end up paying $10 per month for both drugs. And that's it.

Good luck!

Bob

Arent they being penny wise and pound foolish?  The Olysio/Sovaldi combo would cost around $150k for 12 wk treatment and is not eligible for 8 wk duration, whereas for those who qualify, Harvoni is less than half that, and for 12 wks, its about $30k less.. Youve got to scratch your head sometimes about the decisions the insurance companies make.
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #18 on: March 31, 2015, 10:59:59 am »
How long ago was that Vintag54?
 I was reading that Olysio/Solvaldi  was up-tiered and Harvoni down-tiered as of Feb 2nd
I went to my doctor on Friday and I am Genotype 1a and he has put in a request for Harvoni 24 weeks.  I told him all that I read on this forum and ESPECIALLY with UHC and he assured me that I meet all the criteria.  I don't have the results with me and I don't understand all of them anyway but he said something about F4 and severe cirrhosis among other things and he was verrrrrry confident that I would be approved. 
We shall see.  I am anticipating a denial.  I will keep you posted
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #19 on: March 31, 2015, 07:20:52 pm »
Sorry to hear about your lab results Debula, but, congratulations...  I have no doubt that you will be approved since you fall under the UHC guidelines for treatment.  You should have no problems. Best of luck for smooth sailing and complete recovery.

Offline slw304

  • Member
  • Posts: 25
Re: United Health Care and Harvoni
« Reply #20 on: March 31, 2015, 07:24:45 pm »
One question, Debula.  You mentioned last week that you still needed to do the biopsy.  How was your F4 status confirmed this quickly?  None of my business, just curious if there was a way around it.

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #21 on: April 01, 2015, 10:18:20 am »
I did not do a biopsy and again I may not have all the lingo down yet but he did say something about an F4.
Based on a CT scan and something called Fibresure?  I will have to bring my results with me and type out everything so maybe I can understand it all as well.
I asked him about a Fibroscan and he said they don't have that in our hospital but again he was very confident that I should not worry that I more than meet the criteria. ::)
I was also under the impression that a biopsy was needed so I am a bit confused and I am a bit apprehensive that the doctor was a little too confident that UHC was going to pre-authorize me without any problems. 
I guess we shall see.  The lady that was going to be submitting the paperwork told me that I should hear something from them within a week, so I will call on Friday if I don't hear anything before then.  I always worry when I have to leave things into the hands of others.  I will keep you posted
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline SIXFOOTFOUR

  • Member
  • Posts: 89
Re: United Health Care and Harvoni
« Reply #22 on: April 01, 2015, 11:36:43 am »
Hi Deb

I had a biopsy 2 times over the last 10 years., last one was 4-5 yr ago. To be approved by B/C I needed a Fibrosure as an additional test to confirm my F3-4 dx. Fibrosure is a blood test that looks at different liver functions to determine Fibrosis or Cirrhosis

Bets of luck, that test help me get approved

http://www.medscape.com/viewarticle/826834
Sixfootfour
* Contracted Hep C 1971 post transfusion (non A - non
   B Hep dx in 1971)
* Dx as Hep C early 2000
* Geno 1b
* Stage 3-4 Fibrosis by Biopsy and FibroScan
* VL at start of TX > 6 mil
* ALT/AST High normal range at start of Tx 
* Started Harvoni 12 week course 3/6/15 -
   completion 5/29/15
* Undetected at 6 weeks on Tx
* ALT/AST Mid normal range at 6 week blood test
* Completed 12 weeks (84 pills) 6/28/15
* Undetected at 11 weeks & 6 months EOT

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #23 on: April 01, 2015, 11:45:49 am »
Thanks so much.  So I guess maybe I will be approved LOL
I can't imagine that it will be that easy but then again apparently my liver is in bad shape (which is really scary)
It is awful to think that I am grateful for my liver being so bad that I can get approved for Harvoni. :(
 
I really need to bring my results with me and post them.  My way of keeping a journal at the same time
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline dragonslayer

  • Member
  • Posts: 873
Re: United Health Care and Harvoni
« Reply #24 on: April 01, 2015, 02:54:59 pm »
Thanks so much.  So I guess maybe I will be approved LOL
I can't imagine that it will be that easy but then again apparently my liver is in bad shape (which is really scary)
It is awful to think that I am grateful for my liver being so bad that I can get approved for Harvoni. :(
 
I really need to bring my results with me and post them.  My way of keeping a journal at the same time

Listen.. I got approved, first time, no appeals needed, and my biopsies show virtually no liver damage, so you just never can tell.
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #25 on: April 01, 2015, 02:58:05 pm »
That is good to hear dragonslayer!  (Doing a little happy dance)
Did you have UHC also?
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline dragonslayer

  • Member
  • Posts: 873
Re: United Health Care and Harvoni
« Reply #26 on: April 01, 2015, 03:03:25 pm »
That is good to hear dragonslayer!  (Doing a little happy dance)
Did you have UHC also?

No, Ive got a local Connecticut plan called Connecticare.  I was shocked I got approved so 'easily' with my relatively healthy liver, but this was the case.   Its a Medicare Advantage plan which I acquired last June.  I almost went with UHC, but wow, what a good (and lucky) decision I made to go with Connecticare instead!
Paul

DX 2008
Started Harvoni 11/26/14 for 8 wks
Completed 8 wks Harvoni 01/20/15
EOT RNA Quant result:  Detected 29
7.5 wk post tx: Detected < LLOQ(12)
11 wk post tx: UNDETECTED SVR12
24 wk post tx: UNDETECTED SVR24; AST 26; ALT 22; ALP 73
48 wk post tx: UNDETECTED SVR48; AST 18; ALT 18; ALP 70
GT 1a
vl 2.4mil
2008 bpx: Stage&Grade 0
2013 bpx: Stage&Grade: 0-1
IL28B: TT
likely infected early '70s

Offline lockettal73

  • Member
  • Posts: 17
Re: United Health Care and Harvoni
« Reply #27 on: April 01, 2015, 03:37:13 pm »
Wow, this is a lot to absorb.  I have UnitedHealthcare was approved on yesterday; my first 30-day regimen was delivered to my house today.  My doctor submitted my application on last week.  I have no exorbitant copays, either.  UHC covered almost all of the $31,000 for Harvoni.  My copay is $5.  I was reluctant to start the process because of what I had heard about the copays but now I'm glad I did.  I start my treatment tonight.  Wish me luck.

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #28 on: April 01, 2015, 04:08:50 pm »
Wow good news and congratulations!! Good luck with your treatment :)
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #29 on: April 13, 2015, 03:29:30 pm »
Hi all
I just got a call from the Dr. office and I was approved for Harvoni
I think it is for 24 weeks but now I'm not 100% sure because getting the office to tell me anything is like pulling teeth! 
OK this is the weird part.  OptimRX (My plans specialty pharmacy) called them (the Dr.office) to tell them I am approved but now I have to wait for OprimRX to call me to arrange co-pay and shipping details.  (I was told this will take another couple of days)  It seems like they could have just called me to begin with.  I don't understand any of these procedures but I am not going to complain because I am approved!
I do have a question, from what I can find out from the website I see that my co-pay is $113 for 30 days.  At what point can I go to Gilead and ask for a coupon?  Do I need to do that first before I pay my co-pay?  soooo confused
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #30 on: April 13, 2015, 03:52:16 pm »
Hi debula,

I would call your insurance co and ask about the Copay, I'm UNHC and mine is 35, for a 28 pill bottle , they only dispense Harvoni in 28 pills per bottle, and after you take one, you have to have your Dr. Fax the prescription authorization refill to your pharmacy whoever that may be, mine happen to be a no name pharmacy, lol
My first bottle was delivered to my GI, the 2nd bottle I got by Fedex!
I'm thinking my last bottle will be By carrier Pigeon!

I would go ahead a submit your papers to gilead for the reimbursement of the -5$

I truly do share in your grief over this debacle of no procedures, if I'm anywhere right about this I would say that because the drugs are so new and prices are SO High, there are NO set procedures for all providers, and many GI, do not know the ropes on these MEDs And are playing it by EAR !

Great news you got approved, get you some TEETH pullers and go back and See that
Dr., if you need help, tell em Bubbas coming!  Lol

I'm on week 6, can't wait till I'm thru!

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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #31 on: April 13, 2015, 04:00:45 pm »
Thank you Bubba!  Your are half way there!!  How are you feeling?

I went to Gilead website and got the $5.00 coupon so I'm ready LOL

If I don't hear back from OptimRX I am going to just call them myself
(I actually did that last Friday because the lady at the Dr.office kept telling me "it is in the REVIEW process" and sounded bothered my phone calls)  Well today I got the approval.  Coincidence?   Who says being a control freak doesn't pay off? :P

Can't wait to get this started!!
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #32 on: April 13, 2015, 04:24:20 pm »
Hi debula,

I see we are similar in condition, I will say the first week was unusual and kind of strange, I had a fever chills episode on day 6 vomited, very difficult day, since  then I have adjusted to the leg and joint pains and mild headache , some flushing sensation, kinda like a low grade fever, fatigue and for me some slight mental fog, from there until week 5 kinda steady, at week 5, I had another fever, chill, day, but no nausea.
This episode was not as severe as the first one, keep in mind I have varicies and my ammonia was at 222 way high!    So have them check your ammonia and iron!

Today I was at my GP and ask them to do blood labs and they did ! Wow, I'm amazed, I ask them to check my iron and ammonia, also I brought them up to date with all the side effects and episodes I have been thru on treatment.

a little side bar when dealing the.Dr office staff,   Try to be sweet when they act like your bothering them, if you have TOO bride them! they can't take it anyway!  Lol
Get your care, they don't have a CLUE what we have been thru fighting this devil!

If anyone needs sensitivity training it's the DRS office staff! Especially the GI's!
Dealing with hepc patients, mental and emotional stress makes our condition worse!
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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #33 on: April 13, 2015, 04:34:24 pm »
Hi Bubba
Thanks for the tips !! Darn it I was just at my GP office the other day.
He is the best and I can ask him for anything.  If I had known I would have asked him to give me a blood test for ammonia and iron.  I can probably still request it from him.  I don't like the GI doctor or his staff.  Too much in a hurry about everything
I think I may have varicies but I have not done the test yet.  I told the GI doctor that I would do it after I got started on this medication (because I am too chicken and wanted to put if off as long as possible)
So do you think that some of your bad side effects were because of your ammonia levels being high?
Usually I don't respond well to most medications but hopefully this will not be one of them. 
Fingers crossed that your side effects go away for the remaining 6 weeks
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #34 on: April 13, 2015, 05:04:06 pm »
Hi debula,

I think you will be able to tolerate these meds ok, the first 2 or 3 days I felt an energy boost and actually felt good and was even cheerful almost giddy, I kinda thought I was buzzed as strange as that may sound, but as the days wore on I could tell Meds were working, so it's hard to describe but I'm sure you will be able to tell me in a few days..

 Before I started rx, I complained of brain fog, that's when the GI ordered the ammonia test, but he did not check iron, and I was having all the symptoms on HE and my ammonia was real high at 222.   The upper limit for normal ammonia is 122.
High ammonia in the blood is dangerous!
It's strange to me, that unless you complain of a certain symptom, the GI usually does not check everything, Why wouldn't you check everything with a person with cirrhosis ?

I was like you, I requested we wait until I complete tx , before he scopes me, I don't like being put under!  If you control your Bp thru diet and eat only liver diet, you can compensate a lot better...  So for you sake EAT HEALTHY...go low or no salt,no artificial sweeteners , no high fat processed foods, no high iron foods, no red meat, no processed meats, u get the picture, when you are as sick as I was you will do anything to .feel better.  I have lost 10 lbs so, I need to lose 20 more...

I wish someone would have walked me down this path before I walked alone!

I agree with you on the GI, it seems they have too many patients to care well for the hepc patient!


« Last Edit: April 13, 2015, 05:06:56 pm by BubbaT »
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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #35 on: April 14, 2015, 11:18:45 am »
Hi Bubba So what do they do if your ammonia level is high?  I thought I read somewhere that it is high ammonia in the intestines and the fix is laxatives.  Did Harvoni cause the ammonia level to go up so high or?
As for eating healthy that will be the real challenge for me as I eat a lot of junk and processed food and trying to learn what to eat is hard for me but I will definitely try.

As for the brain fog, I have had that for a few years and I told my GP and I guess we thought it was due to my thyroid and hormones in general.  Did not have a clue that the liver caused brain fog until I starting reading this forum.  I don't know what I will do without my brain fog haha

My daughter recently had an app on her iphone for drinking water. LOL  You have a plant and you have to give it water so the app reminds you when to drink water and that in turn waters the plant.  I may use it because I know I won't remember to drink enough water.

What time of the day do you take your meds? 

Thank you again for all the tips you have given me.  You are so nice to take the time to post these things for me/us
 
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #36 on: April 14, 2015, 11:57:55 am »
Hi debula,

First we need to find out what is causing the ammonia level in the blood increase?
At Cirrhosis  the liver is Not Working as well to break down proteins like animal, red meat, and highly processed artificial foods....saturated fats,

If you google cirrhosis and ammonia blood levels you will see what is happening in your blood, when the liver cannot break down the protein, especially animal protein.

Have you noticed after some meals you feel awful? Like high fats meals? With excess protein? Salty meats are bad for you. The salt also makes our condition worse.

I have learned the hard way... I've lost 10 lbs, since I started Harvoni,
Also a good idea is this, I take my meds in the morning with a glass of lemon water,
Squeeze a lemon in a glass of water. The higher alkalinity ph you maintain is better also, because cancers don't survive in higher ph.

Lemon water is good for you, super good...
I quit my coffe, which was prolly good for me, I have started a healthy course to help
Harv do a good job!

Use your googler, a lot of precious information is available to help you know what's going on in your liver and the healthy choices you make will lessen your side effects.

Get well deb

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 debham

  • Member
  • Posts: 68
Re: United Health Care and Harvoni
« Reply #37 on: April 14, 2015, 12:04:48 pm »
Hi Deb, I haven't had a bad time with the med. Tomorrow will be the end of week two. A few strange dreams a few minor headaches but really not bad at all. I make sure I drink a lot of water. At least 64oz a day. I'm hoping and praying this works. I'm still doing my spin class and zumba I'm not going gang busters but I'm doing it. Good luck.
Deb
Diagnosed 2003
VL 300,000
Geno type 1 a
Start TX 4/01/15
VL 2.3 million
Tx Naive
12 wk Tx
Harvoni
Last Ultra Sound
No presents of fibrosis

Offline Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #38 on: April 14, 2015, 04:04:54 pm »
Thanks Debham and BubbaT

Debham- I am so glad to hear you are doing good YAY for 2 weeks!!
What time of day do you take yours?

Bubba- I have noticed!!  I will have to use my googler and and figure out some healthy choices for my meals.  I only drink one cup of coffee a day now so hopefully that is not tooooo bad.  But the lemon juice sounds good too.  I read that the drug needs an acidic environment so I'm guessing the lemon juice is perfect for that.  I don't know how I'm going to drink so much water but at least I like water so it shouldn't be that hard :)


80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #39 on: April 14, 2015, 11:59:46 pm »
Hi debula, have you got your meds yet?

Check out the thread I started in eating to heal your liver!
As a friend, it's the best thing you can do for yourself right now!
So, make it priority to eat well, you can thank me later... Lol

Good God speed on the meds!
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 Debula

  • Member
  • Posts: 257
  • "Your body hears everything your mind says"
Re: United Health Care and Harvoni
« Reply #40 on: April 15, 2015, 10:07:15 am »
Hi Bubba!
I get my meds tomorrow!! (Thursday 4/16)
I ended up calling the specialty pharmacy and they told me I could have called them the minute I knew my pre-authorization had gone through.  That lady at the GI DR office simply didn't know what she was saying GRR makes me so mad.  I would have still been waiting for the phone call.

Anyway... So they are shipping them via UPS overnight and I will have them tomorrow WOO HOO!  I'm scared and excited at the same time.

I have been thinking about "eating healthy" since you brought that to my attention and I was very happy to see your post. Thank you!   It gave me a starting point and I hope more people post there so I can get more ideas.

(I am still trying to decide if I should take Harvoni in the morning or in the evening.  I am leaning towards the evening)

T- minus 1 day to 1st day of the battle to slay the dragon  8)
80's DX: NonA,B
Non responder to Interferon
3/6/2015-GT 1a
VL-1920000 IU/mL
FibroSURE: Fibrosis stage F4 (0.79)
                  Necroinflammat activity A3 Severe (0.75)
AST 88,  ALT 120, Platelets 73
4/16/2015-Started Harvoni (24 weeks)
5/13/2015-4 weeks AST 26, ALT 36 
5/22/2015-5 weeks  VL UND
6/17/2015-9 weeks  VL UND AST 28 ALT 40
7/31/2015-15 weeks VL UND AST 27 ALT 39
9/22 Diagnosed with HCC
10/1-EOT
10/29-SVR4
12/23-SVR12
I AM HEPC FREE! :)

Offline BubbaT

  • Member
  • Posts: 267
Re: United Health Care and Harvoni
« Reply #41 on: April 15, 2015, 08:16:47 pm »
Well good luck, Debula

Get some rest, I know you must be pretty amped up about starting tomorrow, and
Lining your ducks up, but it'll be great and you will get well, YAY!

I go get my 4 week VL Friday, so I will share them when i get them, happy to hear you are starting tomorrow , i know you have been really ready to get this started...

So, heal a liver kid,

Life is good, when you have the Rock...
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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