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Author Topic: Insurance coverage question Harvoni  (Read 8967 times)

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Offline rose12

  • Newbie
  • Posts: 2
Insurance coverage question Harvoni
« on: December 13, 2015, 05:22:16 pm »
I am new to the forum and am so grateful for all of the information shared here:-) my husband has Hep C (bloodwork scan says f2-f4...possible cirrhosis...gi has referred him for an mri and liver 'thump' test to determine fibrosis/cirrhosis) and we are thrilled about the prospect of Harvoni treatment...

I have gathered that the process of preauthorization, denial, appeal, and intense company's looks like a challenging road..we are exploring insurance options for the coming year and would love any insight that you can share. 

We are currently insured by Aetna EPO bronze plan with a high deductible...considering whether to switch to a higher premium lower deductible plan with Aetna or changing horses and going with United healthcare...does anyone have info regarding Harvoni drug copays? Looks like it is a second tier with United and 4th tier with Aetna. Any info or experience would be greatly appreciated...thank you in advance...!

Offline HEPful Guy

  • Member
  • Posts: 13
Re: Insurance coverage question Harvoni
« Reply #1 on: December 13, 2015, 11:38:23 pm »
Whatever you do, stay with Aetna and avoid United Healthcare. Aetna is willing to treat patients with Hepatitis. Their prior authorization process can be a little slow (up to a week), but your husband will be approved for therapy as long as the doctor's office or specialty pharmacy the doctor uses is at least halfway competent at submitting a Prior auth. Whatever you do, avoid United Healthcare for prescription insurance, as they require patients to have F3/F4 status before they will provide coverage for treatment. In regards to the copay, assuming the specialty pharmacy that the doctor sends the prescription to is competent, they should automatically set up a copay card or work on financial assistance for your husband. I wouldn't worry about trying to get set up for a higher premium/lower deductible plan as it wont matter for the HepC treatment, since financial assistance is very easy to receive, especially if the plan is a commercial plan.   All of this is based on this year though, a lot insurance plans change their criteria on who they are willing to provide treatment for at the beginning of the year. The financial assistance shouldn't change with the new year. I would say his doctors office should go ahead and get everything submitted now for approval, assuming they have already done all the basic labs.

Offline rose12

  • Newbie
  • Posts: 2
Re: Insurance coverage question Harvoni
« Reply #2 on: December 14, 2015, 02:32:03 pm »
Thank you so very much for your reply!

Warmest regards and happy holidays:-)

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Insurance coverage question Harvoni
« Reply #3 on: December 14, 2015, 08:16:10 pm »
I suggest contacting the Hep C Careline - www.hepatitisc.pafcareline.org ASAP and ask them - they have a very good handle on who is covering what.
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline sinkers22

  • Member
  • Posts: 6
Re: Insurance coverage question Harvoni
« Reply #4 on: December 17, 2015, 11:32:25 am »
I'm not sure how it is in your state.  I live in Vermont and being treated by a Hepatologist from Dartmouth Hitchcock Medical Center in New Hampshire.  Since I am on Medicare they sent the review to Humana, which approved the treatment at a 20% co-pay for me.  That was still too expensive (About $6,000), so they contacted a foundation that helps people pay for the drug.  You have to be under a certain income level, but it was quite high and we qualified.  I received the drug the next day (12/15) and started taking it yesterday.  I was very grateful. 

Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Insurance coverage question Harvoni
« Reply #5 on: December 17, 2015, 08:30:16 pm »
Good luck Sinkers - may your treatment be easy and successful
Lucinda Porter, RN
1988 Contracted HCV
1997 Interferon nonresponder
2003 PEG + ribavirin responder-relapser
2013 Cured (Harvoni + ribavirin clinical trial)
https://www.hepmag.com/blogger/lucindakporter

Offline sinkers22

  • Member
  • Posts: 6
Re: Insurance coverage question Harvoni
« Reply #6 on: December 17, 2015, 08:39:44 pm »
Thank you.  2 days and so far so good. 

 


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