Genotype 2---GI Suggests Epclusa. However..

[elias]

Hi again:

I learned my genotype is:

Genotype2

My gastro said the appropriate medication for that would be Epclusa.

If I cannot get that approved, he would have to go with some Ribavirin combo, which I dread so much

I am on Medicare.  I do not see Epclusa listed in any of the Medicare Part D Prescription Drug Plans. Though Sovaldi is, as i think Harvoni is as well.

He did ask the secretary to put in a request for Epclusa. But I cant see that they might even consider covering it if its not even on their list. Or am i wrong?

=========================

I also do see that a combination of sofosbovir/daklinza is listed on the AASLD website as an alternative for Genotype 2:

Genotype 2 Treatment-Naïve Patients Without Cirrhosis - Recommended
 

    Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg) for 12 weeks is a Recommended regimen for treatment-naïve patients with HCV genotype 2 infection who do not have cirrhosis.
    Rating: Class I, Level A
     

Genotype 2 Treatment-Naïve Patients Without Cirrhosis - Alternative
 

    Daily daclatasvir (60 mg*) plus sofosbuvir (400 mg) for 12 weeks is an Alternative regimen for treatment-naïve patients with HCV genotype 2 infection who do not have cirrhosis.
    Rating: Class IIa, Level B

 

http://www.hcvguidelines.org/full-report/initial-treatment-box-summary-recommendations-patients-who-are-initiating-therapy-hcv

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I do see Daklinza listed on my Part D list of medications, as well as Sovaldi (Not sure theyd allow for the combination though..)

So my question is why did the Gastro who seems to be aware of the newest of the DAA's such as Epclusa, say he'd have to go with Ribavirin , if the alternative as listed by AASLD (above) is  Daklinza+Sofosbovir



Or is he convinced that the above combo is so expensive, that Medicare would opt for a much less effective--and possibly harmful- tx for my genotype?

Also, i do see the FDA has approved Daklinza+Sofosbovir for Genotype 3. But i dont see they have approved this combination for Genotype 2. Any idea why not?

Gilead cant help me with Epclusa cost, because their discount does not apply to those on Medicare. Neither can the PAN Foundation, because they said they can only help with copayments if your insurance covers it. Medicare doesnt even list it as farf as I know.

I'm very distraught and would appreciate guidance on where to take this further

-elias

[dragonslayer]

So are you on a Medicare supplemental drug plan?  I'm on a Medicare Advantage plan and their formulary usually comes out but once a year.  With all the rapid drug advances the plans can barely keep up.  Just because it's not on the formulary doesn't mean they won't cover.

[elias]

Thanks Dragonslyaer.

I 'm not sure its called "supplemental drug plan".

I know its called Prescription Drug Plan. Is that the same?

Mine is Well Care Classic.

I got the 2017 packet a few days ago, and it still doesnt have Epclusa listed. So I'm worried.  But could that have been put together months ago though?

The irony is that going by the drug cost listed, Epclusa is much less costly than the combination of Daklinza +Sofospovir. So i'd imagine it be in their interest to go with the former.

Unless , they intend to put forth Ribavirin+Sofosbovir as the cheaper "alternative"?

[SusanMac]

Hi Elias,

My husband started Epclusa July 22nd.  He is G2B.  We have Humana Medicare Part D.  Epclusa is a new drug.   It was not listed on Humana formulary.  Takes time to update.   I called Humana.  Would suggest you call your Part D provider and ask if Epclusa is covered and, if so, that a Prior Authorization form be sent to your doctor for completion, to speed up the approval process.

Hope this is of some help.

[elias]

Thanks much Susan.


Your post gives some hope  at least some Part D programs are covering the Epclusa

I was told on this forum that I can change Part D providers at any time. So would be worth finding out which do in fact cover it. Odds are however, that person answering phone would merely look at the Formulary (same way as I have) and see it isn't listed there.

My Gastro has person who works on insurance, so might be good idea for me to convey this dilemma to her

BTW:

I have read that Genotype 3 is significantly more pernicious than Genotype 1.

Would you happen to know if Genotype 2 is more pernicious as well?

Seems few have this GT , so maybe why not much research  on it?

-elias

[andrew j]

It sounds as if you are reasonably happy with your doctor and / or gastro.
When you next see or have contact with them - tell them that you have felt anxious and upset, that you you have been researching treatment options, and that some of the guideline information doesn't make sense to you.

It sounds as he/she/they are willing to try to get the Epclusa for you.
If it's cheaper than any other treatment option - surely that's a no-brainer for the insurance company?
If it doesn't work, appeal, or take whatever action the Patient Assistance Programme suggests, as per Lucinda's full and complete answers on your other thread.


If all else fails, it looks as if SOF & DAC, and SOF & RIBA are both viable options.
In addition there are generics, and AbbVie's pan-genotype combo somewhere in the pipeline.

In short - things are looking good for you, I reckon!

Hoping that this Post isn't too out of date - and that you are OK.

Thinking of you.

A.

[andrew j]

... and no - I don't think geno 2 is any more 'pernicious' that any other genotype.

Back in interferon days, geno 1a used to be considered the most difficult to treat.
Now, it's geno 3.

All of them are scared of these new DAAs!