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Author Topic: denied additional 4wks harvoni (approved only for 8)  (Read 6574 times)

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Offline mae1234

  • Member
  • Posts: 5
denied additional 4wks harvoni (approved only for 8)
« on: December 07, 2015, 08:57:00 pm »
I was approved for 8 wks harvoni based on my low viral load (approx 300,000).  I was still detected at 4 wks (115 viral load) so my doctor advised I need to be on tx for 12 weeks.  I have been denied the additional 4 wks.  I am working on an appeal but the clock is ticking as I only have 3 more pills til I need the new 4wks script!  Anyone else encounter this issue?

Offline beto

  • Member
  • Posts: 548
  • "no risk it, no biscuit"
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #1 on: December 07, 2015, 11:35:16 pm »
Bummer Mae,

You might try to get hold of someone at Gilead or find some creative way to pressure the insurance company (I am assuming that is where the denial is coming from).  I do not know enough details, however,  the specialty pharmacy you are going through may have a friendly ear on staff.  Complain to everyone you can.  Beg your doctor to try to pressure the insurance.   Get a lawyer if you can. 

Was it was easy the first time around? (getting approved)  I was denied 3/4 times and fought like hell, repealed, wrote letters and called everyone I could.  If you only have three pills left someone needs to understand that they are putting you is a precarious situation and going against your specialists orders.  What they are doing is so unethical.  Go to press. 

I was supposed to get 24 weeks but ended up with 12 which turned out to be  the protocol.  However, I never felt comfortable about it and as I got down to the wire, I imagined the "what ifs" so I sort of have an idea what you are going through.

The 8 weeks are likely enough, but fight for four more weeks.  Good luck.  I am sure someone will chime in with better solutions for you...this was a bit knee jerk.
HCV/nonA,nonB acute phase 1975
HCV detected active 1990
HCV persistent chronic diagnosis 1995
1995 liver enzymes mild elevations
1996 Biopsy F2 fibrosis
treatment naive geno 1-A
2000-to early 2015 Viral load 150, 000 to 800, 000
recent liver enzymes before treatment alt/ast 59to209,  Fibroscan F4,cirrhosis
start tx Harvoni 7/11/2015
6.5 week-UD-ast/alt 25/25
9wk-UD-ast18 alt23
10/3/15 completed tx
11/5/15 new fibroscan f0-f1 amazed
6wk EOT UD ast/alt 20/20
12EOT-UD-ast/alt19/21
25wk-SVR! 19/18

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #2 on: December 08, 2015, 06:54:58 am »
Mae, you may be able to get help from a patient assistance program:
http://www.hepmag.com/articles/2512_20506.shtml
Good luck!
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 Rubi

  • Member
  • Posts: 29
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #3 on: December 08, 2015, 10:47:52 am »
My insurance company only approved me for 8 weeks (instead of th recommended 12) for Sovaldi. After my 4week RNA viral load check they approved the other 4 weeks. This is speculation on my part, but if the numbers aren't looking better after 4 weeks the treatment might not be working and may need to be changed. So they don't approve (cost reasons) the last 4 weeks until they see that the numbers look better.

As a self advocate make sure your insurance company knows all of your pre-treatment symptoms and ailments. Make sure they are aware of any treatments, hospitalizations, that they will be paying for if you are not cured.

EXAMPLE: I developed Cold Urticaria from the hep C. This is a life threatening allergy to the cold. I already had one hospital stay and with winter coming on there are many more expected.

Also, contact the specialty pharmacy they are using. They help advocate.

Good luck. Hope it all works out for you. Will keep you in my T's and P's.

Rubi
F 59
GT 2
Started treatment 9-28-15
Solvaldi/Ribavirin for 12 weeks
ALT/AST was 74/48; now 17/17
VL 5.6 million down to 42

Offline beto

  • Member
  • Posts: 548
  • "no risk it, no biscuit"
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #4 on: December 08, 2015, 11:24:47 am »
The numbers are improving...

If the VL numbers are 115 (one hundred fifteen) that is a dramatic drop from 300,000 in just 4 weeks.  There have been folks in that general range at 4 weeks that went on to SVR.  What are your ast/alt at?  You have not posted enough and of course I am not and MD, however again, it seems to early to make a determination.  If your GI wants 12 weeks, he is the expert, not the insurance companies.  Did they wait until the last minute to deny?  Take Gnatty's advice and get hold of patient assistance.  I am pulling for you Mae.
HCV/nonA,nonB acute phase 1975
HCV detected active 1990
HCV persistent chronic diagnosis 1995
1995 liver enzymes mild elevations
1996 Biopsy F2 fibrosis
treatment naive geno 1-A
2000-to early 2015 Viral load 150, 000 to 800, 000
recent liver enzymes before treatment alt/ast 59to209,  Fibroscan F4,cirrhosis
start tx Harvoni 7/11/2015
6.5 week-UD-ast/alt 25/25
9wk-UD-ast18 alt23
10/3/15 completed tx
11/5/15 new fibroscan f0-f1 amazed
6wk EOT UD ast/alt 20/20
12EOT-UD-ast/alt19/21
25wk-SVR! 19/18

Offline jag2455

  • Member
  • Posts: 12
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #5 on: December 11, 2015, 10:10:58 pm »
I chose to self pay because of insurance denial and Harvoni Support Path has a one time only copay coupon which would pay about $23,500 towards one month. I realize this would leave a balance of approximately $7800 but it is worth it if you can afford it.

Contracted (Unknown)
GT 1b - Treatment Naive
9.21.15  Viral Load 975,000 / AST 236 ALT 144
Fibrosure F4 - Cirrhosis / Fibroscan - No Cirrhosis 
10.29.15 - Harvoni-Began 12 week Rx
11.30.15- 4 Wk Labs-UNDETECTABLE / AST 80 ALT 56
12.28.15 -8 Wk Labs-UNDETECTABLE/AST 65 ALT 37
4.29.16 - 6 Mo Check Up Labs Scheduled

Offline mae1234

  • Member
  • Posts: 5
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #6 on: December 16, 2015, 04:29:28 pm »
The day of my last pill in my 8 week course, I was approved for an additional 4 weeks.  Geez, down to the wire! 

Now, I just received word today that my 8 week viral load is 15.  from 115 to 14 between weeks 4-8.  I was so hoping, like everyone, I was undetectable.

I keep reading that viral load results prior to SVR12 is not predictive of outcome at SVR12.  But I can't help but worry.

Does anyone know where I can find data on the roughly 5% that the treatment failed for?  I would like to read the specifics of those individuals and any speculation as to why they were unsuccessful.

Thanks.

Offline Rubi

  • Member
  • Posts: 29
Re: denied additional 4wks harvoni (approved only for 8)
« Reply #7 on: December 16, 2015, 07:17:31 pm »
So glad you got the meds approved. Your numbers look good. Stay positive!
F 59
GT 2
Started treatment 9-28-15
Solvaldi/Ribavirin for 12 weeks
ALT/AST was 74/48; now 17/17
VL 5.6 million down to 42

 


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