User

Welcome, Guest. Please login or register.
April 28, 2024, 02:03:06 pm

Login with username, password and session length


Search

Forums Index

Stats

Members
  • Total Members: 6307
  • Latest: golfer
Stats
  • Total Posts: 55126
  • Total Topics: 4851
  • Online Today: 67
  • Online Ever: 1314
  • (June 22, 2016, 05:23:42 am)
Users Online
Users: 0
Guests: 52
Total: 52

Welcome

Welcome to the Hep Forums, a round-the-clock discussion area for people who have Fatty Liver Disease, Hepatitis B, C or a co-infection, their friends and family and others with questions about hepatitis and liver health. Check in frequently to read what others have to say, post your comments, and hopefully learn more about how you can reach your own health goals.

Privacy Warning: Please realize that these forums are open to all, and are fully searchable via Google and other search engines. If this concerns you, then do not use a username or avatar that are self-identifying in any way. We do not allow the deletion of anything you post in these forums, so think before you post.
  • The information shared in these forums, by moderators and members, is designed to complement, not replace, the relationship between an individual and his/her own physician.
  • All members of these forums are, by default, not considered to be licensed medical providers. If otherwise, users must clearly define themselves as such.
  • Product advertisement (including links); banners; and clinical trial, study or survey participation—is strictly prohibited by forums members unless permission has been secured from the Hep Forum Moderators.
Finished Reading This? You can collapse this or any other box on this page by clicking the symbol in each box.
« previous next »
Pages: [1]   Go Down

Author Topic: Seeking advice on BCBS/ Express Scripts  (Read 10172 times)

0 Members and 1 Guest are viewing this topic.

Offline malou

  • Member
  • Posts: 57
Seeking advice on BCBS/ Express Scripts
« on: November 20, 2015, 11:58:23 pm »
Ok guys, so I was seen in clinic today and they are recommending Harvoni, which I already knew they would. 

I am a non-responder to interferon In 1998, I have known since 1997.  I believe I got it working as a nurse in the ER.

So yippie for the first part.  Now for the insurance part.  I have a blue cross plan which uses Express scripts. 

Anyone have any experience with them?  I have essentially no fibrosis.  They told me at the clinic that it would be denied the first time and I would have to initiate the appeal. 

Any helpful advice would be greatly appreciated.
Logged
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: Seeking advice on BCBS/ Express Scripts
« Reply #1 on: November 21, 2015, 12:40:38 am »
Yes I have express scripts and they make you use their specialty pharmacy branch Accredo at least they did for me I have heard that is not always the case.

I was denied and I have cirrhosis. I ended up getting their attention after I was denied by commenting on an article on their web page so I got an inside email address which worked for me after writing an impassioned email to them. I believe Else had success with a different route. She also has little damage but was able to obtain coverage.

If you are on Facebook you should go to Express Scripts Facebook page it will be "enlightening" when you read the customer comments. That is another place where you can get the magic (as I called it) email address

ExpressRxHelp@express-scripts.com

The best advice I can give is hang in there and don't give up.

I am sure others will add more information about how to appeal.
Logged
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: Seeking advice on BCBS/ Express Scripts
« Reply #2 on: November 21, 2015, 03:42:06 am »
Malou, do you have any extrahepatic manifestations (EHMs) to strengthen your case on appeal?

As you prepare your appeal, here are two specific posts that may be useful:
http://forums.hepmag.com/index.php?topic=3569.msg33507#msg33507
http://forums.hepmag.com/index.php?topic=3457.msg33444#msg33444

and here are some threads with helpful hints sprinkled throughout:
http://forums.hepmag.com/index.php?topic=3591.msg34349#msg34349
http://forums.hepmag.com/index.php?topic=2978.0

Courage and good luck!

Gnatty
Logged
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline malou

  • Member
  • Posts: 57
Re: Seeking advice on BCBS/ Express Scripts
« Reply #3 on: November 22, 2015, 08:23:54 pm »
Yes Lynn, pain, tons of it, everywhere.  Easy bruising, fatigue, depression and anxiety.  I detailed those in my visit on Friday.  We'll see how this goes!  If all else fails, I will be old enough for Medicare in June.  However, I will still probably have express scripts.  I would like to get the tx done before then due to a family situation.  Wish me luck!
Logged
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,544
  • Get tested, get treated, get cured, fight Hep c!
Re: Seeking advice on BCBS/ Express Scripts
« Reply #4 on: November 22, 2015, 08:40:32 pm »
Actually that was gnatty asking about extrahepatic manifestations

Here is a link to a Med scape article about EHM

Extrahepatic Manifestations of Hepatitis C Virus (HCV)
http://www.medscape.com/viewarticle/811058

Mostly what they are talking about is Cryoglobulinaemia, Glomerulonephritis, and Porphyria Cutanea Tarda which you can read about in the link.

Here are some more links from other sources with additional explanation;

from U of Washington Extrahepatic Conditions Related to Hepatitis C

http://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/extrahepatic-conditions/core-concept/all

And a very inclusive list from HCV advocate written in somewhat more laymans like language

An Overview of Extrahepatic Manifestations of Hepatitis C

http://hcvadvocate.org/hepatitis/factsheets_pdf/extrahepatic.pdf

If you can point to any of these diagnoses it could strengthen your case for appeal

Wishing you luck :)
Logged
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Seeking advice on BCBS/ Express Scripts
« Reply #5 on: November 25, 2015, 07:47:52 am »
Hi,
Appeal until you can get it to the external review. Document all your EHMs. A letter from your PCP attesting to the fact you are suffering from, say, severe fatigue will really help. Brendan Bietry at the Patient Advocate Foundation can really help too. My insurance had only covered people on the transplant list-until me. I am F-1. The external reviewers agreed Harvoni was a medical necessity. I got it. The easiest route is to check out the fixhepc website. The generics you will find out about there will cure you. You can have them in hand 10 days after you click enter.
Check my labs below.
Good Luck!
Mike
Logged
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline malou

  • Member
  • Posts: 57
Re: Seeking advice on BCBS/ Express Scripts
« Reply #6 on: November 25, 2015, 05:40:43 pm »
Thanks Mike, I am very happy to see your results!  I had read through your posts about the buyers club and quite honestly am interested in the Mesochem company info. 
Logged
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Seeking advice on BCBS/ Express Scripts
« Reply #7 on: November 25, 2015, 06:11:18 pm »
Hi Malou,
I sent you a message. Let me know here if you reply.
Mike
Logged
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline malou

  • Member
  • Posts: 57
Re: Seeking advice on BCBS/ Express Scripts
« Reply #8 on: November 25, 2015, 06:34:49 pm »
I got it and I did reply.  ml
Logged
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Seeking advice on BCBS/ Express Scripts
« Reply #9 on: November 25, 2015, 06:39:53 pm »
Hi,
I don't see it. Could you resend it?
M
Logged
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline malou

  • Member
  • Posts: 57
Re: Seeking advice on BCBS/ Express Scripts
« Reply #10 on: November 25, 2015, 06:43:30 pm »
sorry, was using the phone, didn't work apparently.  ml
Logged
HCV 1996- Work Exposure ER nurse
GT 1a
Non-responder to Interferon in 1997
ALT 73 AST 21 F1-2
Applied to Insurance for Harvoni 12-15
Denied 12-3-15  Told I would never qualify for Harvoni because I was not 'ill'.
Started Twinvir (Bengladesh Harvoni) on 1/1/16

After 4 weeks ALT 23, AST 15, HCV-RNA UNDETECTED
After 8 weeks:AST 23, AST 11, HCV RNA UNDETECTED
6 weeks post treatment, undetected.

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Seeking advice on BCBS/ Express Scripts
« Reply #11 on: November 25, 2015, 06:58:04 pm »
Got it and replied.
M
Logged
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Seeking advice on BCBS/ Express Scripts
« Reply #12 on: November 25, 2015, 07:24:23 pm »
Malou,
There is good info there under componding daclatasvir as well.
M
Logged
Genotype 1a, Biopsy:11/2014: F-1, Tx Naive
Fibrosure, 7/20/15: F-1-2
Pre tx v/l: 1,600,000, ALT: 75, AST: 48
Started generic sofosbuvir & ledipasvir: 10/23/15
4 wk labs: 11/19/15, ALT: 21, AST: 16, V/L:  UND
Started 8 week Harvoni tx: 11/20/15
8 wk labs, 12/15/15, ALT: 15, AST: 13, V/L: UND
4/11/16 12 week EOT-Undetected
7/5/16 SVR 24
Pages: [1]   Go Up
« previous next »
 

© 2024 Smart + Strong. All Rights Reserved.   terms of use and your privacy
Smart + Strong® is a registered trademark of CDM Publishing, LLC.