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Author Topic: I'm New Here/I Have Humana Medicare Advantage PPO/On SSDI/I Want Harvoni/Scared  (Read 7817 times)

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Offline jkeller0009

  • Newbie
  • Posts: 2
i have a medicare advantage plan through humana with pard d coverage--humana gold ppo. i live in richmond, va and i see a hepatologist at mcv/vcu medical center. i'm 35 years old. i have hepatitis c 1a. through some insane brainstorming, me and my pcp pretty much narrowed it down to i probably caught in 2010. my ast is 66 and my alt is 125. my viral load is 8 million. i really love my doctor and i know he's going to do his best with his team to get me onto treatment. i trust him too--he did his hepatology residency at the mayo clinic...so at least mentally i feel like i'm being well taken care of. i need more blood tests and a fibrosis scan he tells me before we can try to submit for insurance. i have no doubt he will be putting me on harvoni. i already suffer from severe bipolar type I depression with psychotic features, so interferon and ribavirin are out of the picture right now anyway. because of that condition i am on social security disability(ssdi) and i make less than $1200 BEFORE any medical premium deductions. i'm hoping "mysupportpath" can get the monthly copays down to something i could handle. i'm not even sure they'll deal with me since i'm partially insured by the govt. :-/

because of my income, i get from medicare an addendum to my coverage what is called "extra help paying for prescription drugs." this makes it so any medicare covered drug if generic is $2.65 and if brand name it'd be $6.95.

i'm wondering if anyone here has been in a similar situation and knows what would happen in such a scenario, or if anyone here knows anyone who's been through a situation identical to this. i would greatly appreciate any information. i just found out i was sick in december and, i have to admit--i'm just really scared. have been doing lots of crying. my younger brother had cerebral palsy and my mother is just turning 60. i'm going to need to be here to be a caregiver to a certain degree at some point--i can't be suffering the physical and mental issues from chronic hcv.

i live in richmond, virginia, btw. i don't know if that has any bearing on how medicare and advantage and part d work in that region as opposed to any other. and i guess also if you're from virginia--HELLO!!

sorry for my rambling. i'm just--as i said--scared. all i've been doing is sleeping, trying to forget i have 8 million little viral bastards trying to eat away at my liver and i can't do anything about it right now.

luckily i hate alcohol, and i've been eating lots of greens and fruits, as well as milk thistle supplements and lots and lots of water.

i guess i'm just looking for some advice/info as far as dealing with insurance companies' rx approval dpts. and also, i guess, help dealing with being denied. i'm all new at this. i thought i was young and invincible. i'm neither and i could really use some kind words of experience and maybe some online like-situationed acquaintances....josh. :-)
« Last Edit: April 04, 2015, 08:37:45 pm by jkeller0009 »
1a
ast--66
alt--205
VL--8million

Offline BubbaT

  • Member
  • Posts: 267
Hi josh,

I understand your concerns and fears, one good thing you have going for you is
Your young @35,  I'm 57 and have been dealing with hepc chronic since 95 and infected in 76, so the good news is your liver should be in good shape given your age.
And I took milk thistle for 20 yrs.. And a lot of supplements prior to tx.

One thing I would suggest is you eat healthy, rest , talk to your dr about the meds you are taking to see if they are hard on your liver...

Don't eat red meat, limit your salt, sugar, no junk food!
Drink lots of water... Study nutrition , heart smart diet....

Try not to stress about things you cannot control...  Just ask God to help,
Do what is in your power to help your liver and study the forum threads,

Lots of helpful information here, and we support each other...

Keep us posted..
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 HepCFreeAmerica

  • Newbie
  • Posts: 1
Hey Josh. You honestly should not have much to worry about it comes to getting approved through Humana part D. Normally I will have an answer from them within 24 hours as long as I submit all of the documents into them. Not that this matters to you, but in my experience they do not even require a drug test like some of the others. Just make sure your doctor has ordered the following: HCV Genotype, HCV RNA viral load, CMP, CBC w/ diff, PTT, INR, Serum HbsAg, anti-HBc, anti-HBs, anti-HAV, HIV and a test to show your fibrosis level (examples: FibroSure, FibroTest, Hepascore, etc). If you absolutely know you will not fail any drug and alcohol test then you can have that thrown in there too just for good measure. I know all of these labs might seem like overkill but by having everything done it makes it harder for them to say no just because you're missing something.

As for your copay, the Harvoni should only be $6.95. If not, mysupportpath might be able to help you out by signing you up for through the PAN Foundation. However, you can also do this yourself once your medication has been approved.

I hope this helps. All the best to you. Dr. Tom
« Last Edit: May 12, 2015, 09:21:48 pm by Hep Forum Moderators »

Offline jkeller0009

  • Newbie
  • Posts: 2
thank you so much, dr. tom!!  :)
« Last Edit: May 12, 2015, 10:08:41 pm by jkeller0009 »
1a
ast--66
alt--205
VL--8million

Offline davidsconfused

  • Member
  • Posts: 53
I'm on Medicare and Humana Part D. Back in Jan they shocked me by approving me for Harvoni in a day or two. My liver is not great but it's not that bad either.

 


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