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Author Topic: Insurance Companies' Coverage Criteria for Hepatitis C Treatment  (Read 10286 times)

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Offline lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
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 Joe NM

  • Member
  • Posts: 46
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #1 on: January 13, 2016, 04:13:04 pm »
I'm still trying to figure out Express Scripts, if you ever find anything on them...They still cover Viekira Pak for everybody, no restrictions (if you have genotype 1). Up until a couple months ago they were denying all of my clients for Sovaldi unless they were F3-F4...but then they started approving everybody for Sovaldi and Daklinza...so no more discriminating against genotype 2 and 3? Sure hope this lasts.
HCV Case Manager
Type-1 diabetic
Connoisseur of battling insurance companies, and when that fails resorting to 'Sample Pharmacies' and sneaking insulin back from Mexico to survive.
Kindred spirit/admirer of all on this forum!
Here to help in any way I can!
EVERYONE DESERVES A CURE!

Offline FutureThinker

  • Member
  • Posts: 711
  • Onward and upward!
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #2 on: January 13, 2016, 08:16:39 pm »
Thanks much, Lucinda -- excellent information.  FT
Treatment naive
Likely contracted mid-70s
Diagnosed 1a, 2011
F1-2
Harvoni X 12 weeks, completed 5/17/16
Pre-treatment: VL 3 mil, AST 64, ALT 84
4 week labs: VL 30, AST 21, ALT 14
8 week labs: VL UD!!!, AST 22, ALT 16
12 week labs: VL UD, AST 23, ALT 14
2 wk EOT: VL UD
12 wk EOT: VL UD, AST 22, ALT 13 =  SVR 12! Yay! 
Last hep appointment: VL UD, AST 19, ALT 12 = SVR 39! I AM DONE!

Offline Allen Cunningham

  • Member
  • Posts: 59
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #3 on: January 14, 2016, 12:10:53 am »
Diagnosed 8/97 with HepC
Liver Transplant 7/2004
Genotype 1b, Biopsy:12/2015: F-0, Slight Inflammation, TX Naive
v/l: ~600,000 - ~1,000,000 ALT: 26, AST: 26
Starting 12 wks Harvoni in Jan 2016

I have Medicare with Tricare using Express Scripts. I was OK'd for 12 weeks Harvoni with no copay's even though no fibrosis.

I think post-transplant patients are near the top of the list per AASLD criteria

Offline malou

  • Member
  • Posts: 57
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #4 on: January 18, 2016, 09:43:07 pm »
 Joe in NM, I am also in NM.  I was told last Friday that there was no way Express Scripts would ever cover me for treatment, since I had no fibrosis and my labs were so good.  Well according to my guestimate, I think I have had it since 1996.  Lucky that I am not having problems, but still I wanted to treat it.

So, about a month ago, I ordered Twinvir from Bangladesh and paid $1440 for it.  Started on the 1st.  I must say that I am having absolutely no side effects, but am feeling wonderful.  All symptoms of arthritis and fatigue are gone.  I am swimming and hiking daily and have no pain when I wake up.  I was taking either Ibuprofen or Vicodin for my pain at night, but have not taken anything since the first of January.

Since I had two insurances (BSBC and Champva) I am canceling the BCBS tomorrow and in June I will qualify for Medicare.  The $300 per month that I pay for BCBS will almost cover the cost of Twinvir.  And, I understand that Twinvir is going down to $1040 at the end of January for anyone interested.  ML
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 Allen Cunningham

  • Member
  • Posts: 59
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #5 on: January 19, 2016, 04:25:32 pm »
Diagnosed 8/97 with HepC
Liver Transplant 7/2004
Genotype 1b, Biopsy:12/2015: F1, TX Naive
v/l: ~600,000 - ~1,000,000 ALT: 26, AST: 26
Starting 12 wks Harvoni in Jan 2016

Malou - So glad to hear you are getting treatment and feeling so good! What is Twinvir? Is it a generic version of Harvoni or Sovaldi? Do Hepatologist's and Gastro's recommend it?

I saw my Hepatologist today at UC San Fran, and I was worried she was going to put me on Harvoni plus Ribo since I am post-transplant, however she said I could start with Harvoni and they will do Virus levels every two weeks to make sure the virus level is dropping nicely, if not I might have to go on Ribo.

I just took my first Orange Diamond shhaped pill 10 minutes ago, it's quite a beautiful pill, however it doesn't look like $1125.00 worth!


Offline malou

  • Member
  • Posts: 57
Re: Insurance Companies' Coverage Criteria for Hepatitis C Treatment
« Reply #6 on: January 19, 2016, 09:25:26 pm »
Twinvir is the Bangladeshi form of Harvoni which contains Ledipasvir 90 mg and Sofosbuvir 400 mg.  It has been tested in Australia and found to be 99.9% pure (just like any medication manufactured in the US).  The Rx from my hepatologist was for Ledispasvir 90 mg and Sofosbuvir 400 mg, 1 tablet daily for 12 weeks.  Mine had a total cost of 1400 plus $40 shipping, and I believe that comes to about $17 per pill.  Since my insurance has refused any treatment, stating that I am not 'ill enough" even though I have had the virus since 1996, I had no other options.  Ml
« Last Edit: January 21, 2016, 06:31:47 pm by malou »
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.

 


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