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Author Topic: UHC/OptumRx and harvoni??  (Read 5003 times)

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Offline Endless77

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  • Posts: 4
UHC/OptumRx and harvoni??
« on: February 25, 2017, 07:37:46 pm »
I'm wondering if anyone has recently been approved by OptumRx (united healthcare's specialty pharmacy) for harvoni? I know they recently removed the fibrosis restriction from their pre-auth requirements, and was wondering if anyone without fibrosis had been approved? I contacted hcv in 2013. Late last year, I had an abdominal ultrasound (liver appeared normal)  and labs showing mostly normal liver function (AST was slightly elevated), with a viral load of 54,200. Going in for a fibroscan on Tuesday, then my GI will be submitting a pre-auth to United Healthcare.
I know I have a very low viral load and no obvious complications, so I'd like to hear from people who have gone through the approval process.

Also, my UHC plan is through work, not through Medicare or Medicaid (the state I live in contacts w/UHC for some government plans. I know these plans still have the fibrosis restriction). OptumRx manages my pharmacy benefits (some UHC plans use Express scripts).

I hope to hear from someone  :)

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,516
  • Get tested, get treated, get cured, fight Hep c!
Re: UHC/OptumRx and harvoni??
« Reply #1 on: February 26, 2017, 11:27:56 pm »
I do know many were approved by this healthy plan the only way to find out how it will work in your situation is to submit and wait you should hear fairly soon.

I wouldn't waste your energy on worry until you have something to worry about

Good luck!
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Endless77

  • Member
  • Posts: 4
Re: UHC/OptumRx and harvoni??
« Reply #2 on: March 29, 2017, 03:55:22 pm »
So my GI Dr submitted my pre-auth this past Thursday, it's almost been a week and looks like it's still pending. I know these things take time, but the anxiety is crazy! I did call Optum, and they confirmed it had been received & they had everything needed, so it's pending at this point. I'll post an update when I get the decision. Hopefully it's approved and gives hope to others like me w/little-to-no fibrosis that we can still get these meds approved. We'll see!

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,516
  • Get tested, get treated, get cured, fight Hep c!
Re: UHC/OptumRx and harvoni??
« Reply #3 on: March 30, 2017, 09:47:04 am »
Good luck!
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

Offline Endless77

  • Member
  • Posts: 4
Re: UHC/OptumRx and harvoni??
« Reply #4 on: April 26, 2017, 09:16:37 pm »
Endless77
From: Endless77
8:55 PM

So I wanted to let you all know, United healthcare approved 8 weeks of harvoni for me! So they really have removed the fibrosis requirement from their criteria! It should arrive from their specialty pharmacy next week!  ;D

Offline Lynn K

  • Global Moderator
  • Member
  • Posts: 4,516
  • Get tested, get treated, get cured, fight Hep c!
Re: UHC/OptumRx and harvoni??
« Reply #5 on: April 26, 2017, 09:27:41 pm »
Great news endless, congrats!
Genotype 1a
1978 contracted, 1990 Dx
1995 Intron A failed
2001 Interferon Riba null response
2003 Pegintron Riba trial med null response
2008 F4 Cirrhosis Bx
2014 12 week Sov/Oly relapse
10/14 fibroscan 27 PLT 96
2014 24 weeks Harvoni 15 weeks Riba
5/4/15 EOT not detected, ALT 21, AST 20
4 week post not detected, ALT 26, AST 28
12 week post NOT DETECTED (07/27/15)
ALT 29, AST 27 PLT 92
24 week post NOT DETECTED! (10/19/15)
44 weeks (3/11/16)  fibroscan 33, PLT 111, HCV NOT DETECTED!
I AM FREE!

 


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