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Post Info TOPIC: I'm No longer Ranting I am finally on the Harvoni Train. Time to slay a Dragon.


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RE: I'm No longer Ranting I am finely on the Harvoni Train. Time to slay a Dragon.
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Greetings,

I am gathering from the discussion that;

1) "They said and My Doctor said I was approved for 8 weeks of treatment." They being the Doctors Pharmacy, are the first ones to get the prescription. They then submit the claim to the Insurance Company. This is where the Insurance Company gets their Specialty Pharmacy involved effectively transferring the prescription to them.

2) It is possible to have a prior authorization for 8 weeks and have the Specialty Pharmacy show 12 weeks of refills. This is where I have first hand experienced having a Doctor approve me for 24 weeks of Harvoni. The Specialty Pharmacy had refills for the 24 weeks scheduled however 28 days at a time. A complete scheduling of blood letting and other appointments to be conducted throughout the 24 weeks. The Insurance Company ended approval at 12 weeks against my Doctors strong objections and the so called Specialty Pharmacy acting as short stop.

What would not surprise me to see is subsequent to your four week blood draw, if found to be UND at that time, getting shut out of the third bottle of 28 expensive pills. This would be based on the fact that you are qualified for the highly successful 8 week course by nature of your numbers and all related factors.

As time and data progress, the Insurance Companies, who are getting hit hard in this, take advantage of more effective ways to cut cost.

Yes they have to cover you by nature of your policy which is a legal and binding Contract. However they do not have to approve or pay for services rendered beyond the accepted protocol.

Your Insurance Company can make the case that data shows 8 weeks is sufficient in your case. It sounds like the initial order may well have been for 8 weeks at your Doctors Pharmacy.

In my case, the Insurance Company was right. The 12 weeks did it and to be honest in retrospect, I am glad as can be they cut me off. That 5:55 stuff was getting old.

JimmyK



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."



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Bilbo,

That is a good blood draw regime.

Additionally, to the schedule you have shown here, if you were on an 8 week course, I would expect an end of treatment (EOT) 8 week PCR, OR, if you were on a twelve week course, I would expect an (EOT) 12 week PCR.

Seems more and more people are getting 8 week treatments nowadays (but when justified by parameters - some of which Tig mentioned). I do wonder how far reaching the insurance dictates go - we had one fellow here fully expecting a long course of harvoni, suddenly and unexpectedly he was informed he did not need the longer course, that a shorter one was all he needed. Perhaps if you fit the "picture" before treatment (the parameters Tig mentioned) AND you DO respond PERFECTLY, EARLY (as proven by your blood draws) - they can make that decision (to shorten your course) while you are still on treatment? Just a thought ... I really have no dea how your system works down there - but that might explain why one pharmacy says 12 the other say 8 - they haven't made up their minds yet?, until the first early blood test jury returns? Maybe "approved" for 12 doesn't necessarily mean you will get 12, depending on your response to treatment, and if no other pre-existing parameters support needing a long course?  No idea, I'm just guessing! 

I just don't want you to be surprised if something like that ever occurred, likely it won't, the main thing is I just  don't want you to be worrying about it - they will NOT allow you to be NOT cured after such an investment in you!, whether it ends up being an 8 or 12 week length. Many people are starting to get 8 weeks courses nowadays, and are being perfectly well cured. Bonus for the patient too, the shorter treatment times. smile C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 62 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)

Tig


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As long as it hasn't left the control of the pharmacy and wasn't opened, it won't vanish! That's worth around $30K, and is under lock and key...



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Tig

61 yo GT1A - 5 Mil - A2/F3 - (1996) Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 1-4 years!

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My insurance company would only allow 28 days at a local pharmacy all others must be sent directly from the insurance company Pharmacy. It is weird š that a whole month of a very expensive drug was going to just vanish like that š¤

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Harvoni 12 weeks

51yo Cont 1983 by Blood Trans Diag 2003

viral load test 2.8mil

Geno type 1A

TB Test Neg

Eye and Retna Norm

Liver function test. F1

ultrasound of my liver F1

Tig


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Your blood work orders look correct and will tell you exactly how things are progressing. I'm pleased to see an order like that. The 8 and 12 week tests will be on the same order. You will also have them again at the 12th week following the end of treatment to determine if you have achieved SVR.

Looking at your history, you qualify for the 8 week Harvoni treatment. You are treatment naive, viral load is below 6 million, and your low fibrosis stage is a plus. I would opt for the 12 week course as well, if your coverage meets it and seems it has.

The pharmacy issue is strictly financial. There is big money made on these drugs. It's a sad truth, everyone that touches the prescription, makes money. A 12 week course of Harvoni (retail) is approximately $94,500.00. The profit pie is divvied up by all of the players. Many insurance providers don't give you a choice of pharmacies. Unless of course you pay for it out of pocket.



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Tig

61 yo GT1A - 5 Mil - A2/F3 - (1996) Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 1-4 years!

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I'm No longer Ranting I am finally on the Harvoni Train. Time to slay a Dragon.
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Week 1 Diagnosis B18.2 Test CBC\ w Diff Baseline

Week 2 Diagnosis B18.2 Test CBC\ w Diff ,Hepatic Function Panel (AMA)

Week 4 Diagnosis B18.2 Test CBC\ w Diff ,Hepatic Function Panel (AMA),Hepatic c RNA, Quant RT PCR

That's all the Orders I have but I have been told I need Blood Tests at 8 and 12 weeks too I just don't know what.

The Doctors office is pissed off that I didn't go with their Pharmacy.  Their Pharmacy keeps calling to see if I will transfer the Prescription there.  I wont.  They said and My Doctor said I was approved for 8 weeks of treatment.  I know that I have been approved for 12 because that's what my insurance company's mail order pharmacy is filling.  Something is going on here that doesn't seem right.  I think I would rather take 12 weeks rather than 8.



__________________

Harvoni 12 weeks

51yo Cont 1983 by Blood Trans Diag 2003

viral load test 2.8mil

Geno type 1A

TB Test Neg

Eye and Retna Norm

Liver function test. F1

ultrasound of my liver F1



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No longer Ranting on Harvoni
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Hey Bilbo,

Congrats man! 1 out of your 12 weeks of Harvoni done! Glad to see you posting in your very own "On Treatment" thread! Such a long journey for you, to finally get here, on treatment, but you did it!, past all the delays, frustrations and obstacles! Big progress!

You'll see, when this 12 week treatment period is done, you will find this part went fast!, comparatively, to how slow things were moving for you prior.

Tig (and you) are correct in your surmizing and predictions, and we all hope to see you adjust to being on harvoni right shortly, with no big swings in how you are feeling. Sorry about the "cow-killing" headache, hope that does not happen again for you - keep dousing anything like that with water, just like you have been doing. And try not to work too hard. Not overdoing things, rest, treating yourself with gentle care is important too. Listen to your body - it's making up all the rules for the moment - craving fish?? - go for it. Why not. Good things within reason.

If gingersnap cookies work for you, great. Who knows, maybe gingersnap cookies work just as well as any other form of ginger, if one thinks ginger helps settle a stomache or quells nausea.  I've never tried ginger snap cookies to soothe an upset stomache. I've never tried Tig's ginger ale recipe either, but most folk I have heard of, have tried ginger in various forms, some, in the more raw, juiced, or more concentrated forms, rather than regular gingersnap cookies. My Mom used to just give us kids regular ole commercial gingerale. I remember my Granny giving us tablespoon sips of real "ginger beer", when we were little tykes and when us "little lambies were feelin' poorly" - that's how she used to say it (she hailed from North Carolina). Don't know if it was the ginger beer or just the doting loving care, but mostly our tummies got to feeling better. My Granny loved candied ginger, yuk. I like ginger best, and lots of it, sliced up in a nice sizzling hot wok of chinese chop suey! No so practical if I had a queasy stomache!!

I hope this coming week and every week after just keeps getting better and better for you, I can't wait to hear some of your next good news blood works to come!

Remind me again please, when are your next planned doc visits, and lab draws, through treatment? How many VL's and LFT's will you be getting and when?

Yay Bilbo, you're killlin' it!biggrin C.



-- Edited by Canuck on Thursday 18th of May 2017 12:46:22 AM

__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 62 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)



Veteran Member

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I'm No longer Ranting I am finally on the Harvoni Train. Time to slay a Dragon.
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http://hepcfriends.activeboard.com/t63209883/taking-a-class-before-starting-harvoni/?page=2&sort=newestFirst

I started here in February after I was getting the Run around by my Doctor.  Thanks to the support of the members here I just finished my first of 12 weeks on Harvoni. One week completed. Kind of like a rollercoaster of symptoms. Fatigue and boundless energy come in waves. Sometimes weakness most often is tenitus. Strange muscle and joints soreness. Yesterday I had a headache that would kill a cow. I have been avoiding otc pain killers because I heard some are processed by the liver. Ginger snaps for heartburn The best advice anyone has lots of water which is my constant companion. One person at work asked if I was dating my water bottle. I've also been having a lot of cravings for fish I'm not sure if that has anything to do with it. Thank you for all the wonderful advice you guys have been absolutely a godsend. As week 2 starts I'm looking forward to the side effects being more stable after my body gets used to Harvoni.          

 



-- Edited by Bilbo626 on Thursday 18th of May 2017 10:17:46 AM



__________________

Harvoni 12 weeks

51yo Cont 1983 by Blood Trans Diag 2003

viral load test 2.8mil

Geno type 1A

TB Test Neg

Eye and Retna Norm

Liver function test. F1

ultrasound of my liver F1

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