Question about Viekira Pak and getting medicine

[brb93]

What are the chances of getting approved for this? I was diagnosed in May and I have mild liver damage. My doctor sent a pre auth for Sovaldi but I was told it is very rare to be approved without being in a later stage. I have Medicaid, and I'm very much expecting a denial to the appeal. The Support Path's recent changes means that while I have insurance, I can't sovaldi.

I was told when I come back, assuming it's been denied twice, they'll send off a script for Viekira Pak. What are my chances of getting this approved? Originally, I didn't have a lot of worry about getting medication. I was told if insurance denies it twice, I'll get it anyway. Now that's all changed, and I am worried about getting medicine. I'm not even sure if there are any druga besides Harvoni, Sovaldi, or Viekira. My main worry is not being able to get any medicine for it. I'm all new to this.

[Else]

Hi Brb,

Medicaid benefits differ from state to state.  Where are you?

[brb93]

I'm in Kentucky.

[Tom1952]

Thank you for sharing this information about Giliead.  It is discouraging but it is better to have information.

I was diagnosed in 2004 with Geno 1a.  I have never been treated for HepC; was always concerned the side effects of the earlier treatments would not have allowed me to work and that was not an option.

During the last year my fatigue and brain fog have gotten much worse, and with the good news about Solvadi and Harvoni I have made an appointment to see my gastroenterologist (8 week lead time) to discuss treatment.

Currently I am uninsured.  I make just enough to be out of the ACA guideline and not enough to really afford coverage.  I was counting on help from Gilead and now not sure what course to take.

This forum has been a source of information and encouragement to move forward and try to get treatment.  Even if the path to treatment for me is not sure or clear.

Thanks
Tom

[Else]

Good news for you yet, Tom.  The Support Path with Gilead is still up and running.  Funding full course of treatment for Harvoni for those that are uninsured!
The cuts they made on July 1st included those of us WITH insurance who were denied because we didn't meet our insurance company's definition of "medical necessity".

Your current lack of insurance turns out to be a wonderful thing!!!  Contact www.mysuppportpath.com asap and get started!

Thank you for sharing this information about Giliead.  It is discouraging but it is better to have information.

I was diagnosed in 2004 with Geno 1a.  I have never been treated for HepC; was always concerned the side effects of the earlier treatments would not have allowed me to work and that was not an option.

During the last year my fatigue and brain fog have gotten much worse, and with the good news about Solvadi and Harvoni I have made an appointment to see my gastroenterologist (8 week lead time) to discuss treatment.

Currently I am uninsured.  I make just enough to be out of the ACA guideline and not enough to really afford coverage.  I was counting on help from Gilead and now not sure what course to take.

This forum has been a source of information and encouragement to move forward and try to get treatment.  Even if the path to treatment for me is not sure or clear.

Thanks
Tom

[Tom1952]

Else

I have already contacted MySupportPath and am just waiting to see my Gastroenterolgist in August.  After he completes the the referral form I can submit to Gilead and then start the process.

Thanks for the kind words. 

[brb93]

So does anyone know anything about my question?

[Else]

Check out this link - it's pretty current (7-1-2015)

https://mediproviders.anthem.com/.../KYKY_CAID_Formulary.pdf

Viekira Pak is not on this formulary.  But if someone told you Viekira Pak is an option after a Solvaldi denial, I would contact that person again. 

Your doctor is correct - it will be difficult to get approved with only mild liver damage.  Please double-check this, but I believe Kentucky Medicaid requires a minimum Metavir score of F3.  The requirements differ from state to state.  Anywhere from F2 to F4, depending on where you are.

It sucks. 

[dragonslayer]

Not sure about Medicaid, but in general, many of us with no to minimal liver damage somehow, managed to get approved. I was approved with a stage 0-1 scoring first time with no appeal.. I have a local medicare advantage plan in Ct.

[DeathtoHep]

The way i got on VP went like this:
1) applied through insurance (denied, not enough damage)
2)appeal decision(denied, same reason)
3)called Abbvie and they said as long as i made less than 100k a year I would qualify for their patient assistance program and they would ship it for free.
4)endless phone calls back and forth between insurance, provider and abbvie but finally set up a shipment. The whole process took about 6 months.

Here is the number to Abbvie. Ask about their program and what you need to qualify. I dont know if I was just lucky or anyone can do this.
(844)277-6233

[Joe NM]

brb93: Viekira Pak only works on genotype 1. It has to be taken with ribavirin if you're genotype 1a, no need for ribavirin if you're 1b. The Patient Assistance Program run by the company that makes V-Pak is called "proCeed" and they would definitely send you the medications free if your insurance denies it twice. Just stick with it and stay in touch with your doctor's office, and you can access it!
If you have genotype 2 or 3 it can be more difficult, since if your insurance denies it there is no program to get free Sovaldi or Daklinza (current standard of care for genotype 2 is 12 weeks of Sovaldi and ribavirin, for genotype 3 it's either 24 weeks of Sovaldi and ribavirin, or 12 weeks of Sovaldi and Daklinza).
If you have genotype 4, the same people who make V-Pak have a new combination therapy called Technivie. If insurance denies you twice for that, then you can get that medication for free from proCeed as well. But it only works for genotype 4.
Also, by "denied twice," that means a Prior Authorization was denied (that's the initial request your doctor's office or pharmacy has to send off to the insurance company, along with lab work, etc.), then you have to file an Appeal. Information for filing an appeal has to be included with any denial letters sent by insurance.
You need copies of the letter insurance sends telling you were denied both times, and proof of income. If you can put those together, you can apply for the Patient Assistance Program with proCeed. You can get more info on this at viekira.com

[DeathtoHep]

I would like to add to Joes response. This is exactly how I got on VP. It took me two calls to Proceed and I got it for free. There will be a lot of back and forth between them, your insurance and your provider but just stay ontop of it.

The number I used to contact Proceed was: 844 277 6233