Welcome, Guest. Please login or register.
July 22, 2024, 07:23:11 pm

Login with username, password and session length


Members
Stats
  • Total Posts: 55130
  • Total Topics: 4851
  • Online Today: 204
  • Online Ever: 1314
  • (June 22, 2016, 05:23:42 am)
Users Online
Users: 0
Guests: 55
Total: 55

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.

Author Topic: Wife has just tested positive for HepC  (Read 16456 times)

0 Members and 1 Guest are viewing this topic.

Offline Cure

  • Member
  • Posts: 4
Wife has just tested positive for HepC
« on: March 19, 2016, 10:09:03 am »
Hello,

I am a newlywed and my wife has recently tested positive for HepC.  I love her very much and she is a wonderful person that I'm trying my best as a husband to help her fight.

I have read that their are cures now, that come with an insane price tag.  We are in our early 30s and I wanted to know a few things.

-Has anyone in a similar situation been able to get their insurance companies to pay for the HepC treatment?   I'm afraid we'll be denied because she is young and newly diagnosed.

-Has anyone used or know in more detail about Zepatier form Merck?  If so, do they have any programs that we could apply for to get a discounted rate of the drug?

-Also, I've read of a man name Greg Jefferys, has anyone sought out his services on these forums?

I have read through these forums and knowing that a support structure like this exists brings us hope and gives us a positive outlook to our situation.

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #1 on: March 19, 2016, 10:18:57 am »
Hi,
Read all my posts. Check FixHepC.com. You can go with Greg, but there are cheaper ways. He is dependable. Also, check out the Delphi site in my signature. You can get insurance to pay, but it can take a long time. If you have $900, she could be taking her medicine in 10 days.
GP2U.com can get her in the REDEMPTION clinical trials for $2000. It has a 95% SVR 4 rate. Early results are going to be presented next month at EASL.
Now, more on insurance: It took me 7 months to get to see my GI to get my last prescription. That was my 3rd. I had to fight them through three denials until I was approved by the independent external review based on severe EHMs. The insurance companies have eased up on their restrictions, but think in terms of months or more to get a shot at her being approved. There is a lot to learn. You have started in a good place. More info would help people give you better advice. Genotype, etc.
Good luck.
CM
« Last Edit: March 19, 2016, 11:00:56 am by Coach Mike »
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 Cure

  • Member
  • Posts: 4
Re: Wife has just tested positive for HepC
« Reply #2 on: March 19, 2016, 10:34:16 am »
Hi,
Read all my posts. Check FixHepC.com. You can go with Greg, but there are cheaper ways. He is dependable. Also, check out the Delphi site in my signature. You can get insurance to pay, but it can take a long time. If you have $900, she could be taking her medicine in 10 days.
GP2U.com can get her in the REDEMPTION clinical trials for $2000. It has a 95% SVR 4 rate. Early results are going to be presented next month at EASL.
Good luck.
CM

Isn't it difficult to get something from Beijing Mesochem to the US?

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #3 on: March 19, 2016, 10:41:17 am »
No.
Register at FixHepC.com. I am a moderator there. I generally send a PM to all new members. If I don't, send me one.
« Last Edit: March 19, 2016, 10:45:18 am by Coach Mike »
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 Mike

  • Member
  • Posts: 999
Re: Wife has just tested positive for HepC
« Reply #4 on: March 19, 2016, 01:08:08 pm »
Hi,

Being a women of child-bearing age with the intent to have children is a qualifier for many insurances plans. You may want to discuss this with your wife and doctor.

Best wishes, Mike
Genotype 1a
Treated 2001 with PEG and RIBV
Treated in 2014 SOL+PEG+RIBV
Cured July 2014

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #5 on: March 19, 2016, 03:43:06 pm »
Good points Mike,
That is what insurance is for. Find a doctor, tell him or her you want to start a family yesterday. If they won't fight for you, find another one. In the meantime, get all the tests: fibrosure or scan, viral load, CBC, CMP. Get copies and scan them for future use, along with a written copy of the medication prescribed. If the insurance company tries to stonewall, you will have the documentation needed to use your other options. Play the "wanting to start a family" card first. If you are denied, then you will probably be looking at a fight for insurance coverage.
At least now there are viable, affordable, proven alternatives.
I know, I got the generics and fought and got insurance coverage.
It can be done if you fight.
CM
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 J.R.

  • Member
  • Posts: 38
Re: Wife has just tested positive for HepC
« Reply #6 on: March 19, 2016, 10:11:09 pm »
Cure,
Coach Mike gives some good advice, but "your mileage will vary" will dealing with treatment. On the flipside, I had a doctors visit the last week of January, informed my GI I wanted to start treatment. He ordered the necessary tests. Less than two weeks, insurance notified me they approved treatment (harvoni) and NO $$ as between my and spouse's insurance it was covered.  I started taking Harvoni the weekend after Valentines Day.
And as CM said, get the necessary tests done so the GI doctor can set a course of treatment for your wife. Praying for a positive outcome.
Contracted-mid 80s
Diagnosed- 2008
Treatment Naive
AST-34 (01-16 test)
ALT- 71 (01-16 test)
VL-4.1 mil (01-16 test)
GT- 1a
Fibrosure-0.33 (F1-F2)
Harvoni tx start 2/20/16
HCV RNA Quant- undetected (3-7-16)
AST-16. ALT-30 (3-7-16)
AST-19. ALT-39 (3-21-16)
HCV RNA  Quant- undetected (3-21-16)
AST-17, ALT-38 (4-1-16)
HCV RNA- Undetected (4-1-16)

EOT-4-15-16
HCV  RNA- UNDETECTED
AST- 21  ALT- 42

4 wk EOT (5-13-16)
HCV- undetected
AST-17  ALT- 36

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #7 on: March 19, 2016, 10:48:08 pm »
More good points JR,
It all depends on how you, your doctors and your insurance company can work together and get it done. That hard fact is this: the insurance company will have to pay Gilead, or whoever, $40,000+ for the treatment. Anyway you view that, its a lot of money. So, they might just pay up or try to stall. Whatever happens, someone has to foot Gilead's bill. Insurance companies are businesses. You don't read about them going broke. Premiums will rise. In the end, the clients will foot the bill.
Gilead spends $99 on advertising for every dollar spent on research. I can document that.
If I seem bitter, its because I am.
This is simply wrong.
They have made enough money on sofosbuvir. Its time for the price to come down to a realistic level.
The global market seems to place that around $1000 for a 12 week tx.
Don't get me wrong here, go after your rightful coverage and fight like hell if need be.
Wishing you and yours good luck,
CM
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 Cure

  • Member
  • Posts: 4
Re: Wife has just tested positive for HepC
« Reply #8 on: March 21, 2016, 01:03:13 pm »
Cure,
Coach Mike gives some good advice, but "your mileage will vary" will dealing with treatment. On the flipside, I had a doctors visit the last week of January, informed my GI I wanted to start treatment. He ordered the necessary tests. Less than two weeks, insurance notified me they approved treatment (harvoni) and NO $$ as between my and spouse's insurance it was covered.  I started taking Harvoni the weekend after Valentines Day.
And as CM said, get the necessary tests done so the GI doctor can set a course of treatment for your wife. Praying for a positive outcome.

Thank you all for the help and support.  Another question I have is what insurances have you guys used that hasn't given too much push back to get your treatment?

Our current insurance is Kaiser in Virginia and I'm dreading the idea that they are going to reject us.  If they do, I wonder if I am able to switch to another insurance company that would more likely cover my wife's treatments?

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #9 on: March 21, 2016, 08:19:28 pm »
Hi,
You need to ask Kaiser for a copy of or a link to their criteria for treatment of HCV. That will give you a better idea of your chances. If you are considering switching companies, the same applies. They are going to have to pay $40,000+ for the medicine. Many are difficult to deal with. Some, far worse than others.
My BCBS was horrible. Maybe some of the people who breezed through the approval process could give you a company name. I read about people saying how easy it was, but don't see many insurance companies being mentioned.
Knowing what I know now and given the current situation with generics, I wouldn't fight them 2 years for coverage.
I would simply pay the $1000 and get well.
CM
« Last Edit: March 21, 2016, 08:22:35 pm by Coach Mike »
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 J.R.

  • Member
  • Posts: 38
Re: Wife has just tested positive for HepC
« Reply #10 on: March 21, 2016, 11:44:23 pm »
Cure,
My insurance was Anthem Blue Cross. As one poster mentioned with your wife being of child-bearing age that should be her ticket to qualify for treatment. Let her PC know you are wanting to start a family. Then a referral to GI should get the ball rolling for you.
Contracted-mid 80s
Diagnosed- 2008
Treatment Naive
AST-34 (01-16 test)
ALT- 71 (01-16 test)
VL-4.1 mil (01-16 test)
GT- 1a
Fibrosure-0.33 (F1-F2)
Harvoni tx start 2/20/16
HCV RNA Quant- undetected (3-7-16)
AST-16. ALT-30 (3-7-16)
AST-19. ALT-39 (3-21-16)
HCV RNA  Quant- undetected (3-21-16)
AST-17, ALT-38 (4-1-16)
HCV RNA- Undetected (4-1-16)

EOT-4-15-16
HCV  RNA- UNDETECTED
AST- 21  ALT- 42

4 wk EOT (5-13-16)
HCV- undetected
AST-17  ALT- 36

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #11 on: March 22, 2016, 06:18:35 am »
Thanks JR,
Knowing that a company has approved soneone for expensive drugs gives hope.
Hope used to be about all one had when dealing with this crap.
No more.
CM
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 Baxter

  • Member
  • Posts: 87
Re: Wife has just tested positive for HepC
« Reply #12 on: March 23, 2016, 08:53:49 pm »
From a pure cost/benefit perspective, it seems to me that paying for the treatment now rather than a transplant and a lifetime's worth of anti-rejection drugs later is the more pragmatic decision for an insurance company. As expensive as it is, the numbers only get bigger the further down the road you go. What am I missing in this equation?
Gen 1a
Inf. '85
Dx '98
'98 biopsy - Grade 2, Stage 2, VL 7 mil
'01 biopsy - Grade 1, Stage 1, VL 1.5 mil
'08 biopsy - Grade 1, Stage 1, VL 3.5 mil
'12 biopsy - Grade 1, Stage 1, VL 3.5 mil
'16 Fibrosure - Grade I, Stage 3, VL 6.4 mil and 4.8 mil
4/23/16 - ALT 89, AST 50, pltlts 120k. Started 12 wks Harvoni
4/31/16 - ALT 30, AST 21, pltlts 125k
4/14/16 - ALT 25, AST 16, pltlts 126k, VL 69
5/11/16 - ALT 28, AST 21, pltlts 140k,VL <15
6/7/16 -EOT, UNDETECTED!
9/7/16 - cured. Low Stage 2 fibrosis

Offline Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #13 on: March 24, 2016, 12:11:50 am »
I offered to buy Harvoni out if my pocket at 100% co pay if my insurer would approve coverage. I simply wanted to be able to get it at their discount. Their answer: " We don't negotiate". Thats how stupid they can be. After all, its not like they are going out of business. They will get their money back in higher premiums. Never heard of a health insurer going broke. They need to send their clients to India. They could save a ton. But, its not their money.....
The bad guy is Gilead. The good guy is generics.
CM
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 lporterrn

  • Member
  • Posts: 1,969
  • LucindaPorterRN
    • LucindaPorterRN
Re: Wife has just tested positive for HepC
« Reply #14 on: March 24, 2016, 11:48:16 am »
Cure - I think that your questions about coverage and considering generics are premature. If you wife says she is wanting to get pregnant, she is very likely to get treatment approved. Rather than speculate, I suggest seeing what happens. Too soon to assume there will be obstacles.
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 Coach Mike

  • Member
  • Posts: 292
    • Affordable Hepatitis C Treatment
Re: Wife has just tested positive for HepC
« Reply #15 on: March 24, 2016, 12:10:56 pm »
Lucinda is right.
Thats what insurance is for. Start the process, because thats what it is, a process. From diagnosis, to the GI appointment, to the insurance company, to the specialty pharmacy. It is a process. One step at a time.
Maybe, in a few years, it will be like a bladder or prostate infection, go to your PCP after the diagnosis and tests, get a prescription called in and pick up your medication. I have never seen a GI for my HCV, only an APN. If no other issues are present, treating this disease is fairly simple.
Start the process.
CM
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

 


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