Genotypes

[Kristen84]

I was recently diagnosed with hep c can someone t
Explain genotype...also is it common for insurance companies to not cover the treatment til damage is already done

[Lynn K]

Hi Kristen84 and welcome

Here is a link to a small article about Heo C genotypes

http://www.hepatitiscentral.com/hepatitis-c/hepatitis-c-genotypes/

But basically I am sure you have heard about different flu strains like bird flu or swine flu etc. They are all more or less the same just different strains of the same basic virus. Same thing with hep c Genotypes. There are more genotype 1's in the US while in other parts of the wirld you will find more people have genotype 4. They all are hepatitis c but some seem to be a bit more aggressive in causing harm and they do sometimes require different medicines to treat with.

As far as getting insurance approval yes many insurance won't prescribe initially without the patient having liver damage. However that is not true for all insurance companies the only way to know is to see a doctor and submit to your prescription drug insurance. You can also call them and inquire for their policies but it can be difficult getting someone who can and will answer your question correctly.

Even if you are denied you need to appeal from what I have read here at least 3 times and if still denied you can request an independent review and also take it to your state insurance commission. But others here know more than me about how to appeal. I was only denied once by my insurance as I have liver cirrhosis.

But first thing is to see a liver specialist familiar with treating hep c who is willing to work with you if you need to appeal. You will have testing to determine your genotype to determine the correct treatment for you. Also you will be tested for your viral load to see how much virus is in your blood. Your doctor will need to determine how much if any liver damage you have. There are several tests they can use for this. Then you can submit your prescription and hope your insurance is one of the easier ones to get approval.

If you want you can say which insurance you have so other with the same insurance can let you know about there experiences. For example I have BCBS of Illinois as my company is HQ in Chicago although I work in Washington state and my prescription drug coverage is through Express Scripts for most meds and their speciality pharmacy Accredo for medicines like hep c meds like the Harvoni I treated with.

Good luck and let us know how it is going
Lynn

[Kristen84]

Thank u so much for all the info Lynn!! I have blue cross community through public aide. In my book I have thru them it says it covers sovaldi and interferon but not having

[Kristen84]

I just went to a gastrointestinal Doctor for the first time yesterday. I was diagnosed with hep c end of October. I've had it for about a year and a half now. My reg doctor tested my levels and in December they were 799,000. So still low. But the liver doc had me do blood work yesterday to check my liver enzymes and to find out genotype. So I'll find out this week sometime. It's very scary having this virus let alone not having the money to pay for these medications. Hope my insurance will pay otherwise I'm screwed

[gnatcatcher]

Kristen, you're not screwed. There are other threads on these forums that explain how to get help from a patient advocate, how to appeal, etc. But first things first: some gastroenterologists have staff who are very good at getting insurance to approve their patients' treatments. If it turns out you get good help from the staff, you won't need the information in those other threads. If it turns out you need that information, I or another forum member can provide you with links to those threads.

Gnatty

[Kristen84]

Thank u gnatty for the information

[Lynn K]

Kristen

On thing you have on your side is time. They will eventually figure out how to get all patients treatment without all the hassles we have right now.

I had hep c for 37 years and it took me 30 years of being infected before I was diagnosed with cirrhosis. Not everyone develops cirrhosis even after many years only about 20% progress to cirrhosis.

I guess I am just one of the "lucky" few.

Things woill work out for you one way or the other you will be treated and cured.

Another avenue as an option is participating in a clinical trial you get the meds for free and often they are looking for people who are less sick.

Our dear Lucida was cured on a clinical trial. I participated in 2 clinical trials but it was long before the new meds were invented.

There is more than one way to slay the dragon keep looking for options

[Kristen84]

Thank you so much for the information!!! I wanted to share with u guys that I spoke to someone from my insurance company and the told me they will cover harvoni now even in early stages of hep c they just have to go through what they call a "specialty pharmacy"  to get the medicine. I'm so relieved!!! It's so sad that insurance companies deny ppl who need meds. They let ppl get sick before they consider covering things. Thanks again for sharing ur experience with me. It's so helpful for me cuz its so new for me. I just read things and get myself worked up.

[gnatcatcher]

Good -- I had read that some major insurers decided to cover everyone beginning January 1 of this year. Going through a specialty pharmacy is common for Harvoni -- mine came from CVS Caremark specialty pharmacy, and they were easy to work with.

Best of luck to you, Kristen.

[Lynn K]

My prescription drug coverage is with Express Scripts but for expensive meds or meds that need special handling like injectables those are provided by their speciality pharmacy Accredo I assume using a specialty pharmacy for these types of meds is a common practice

So happy things look like they may be improving for people to get the new treatments and not be denied

Good luck