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Post Info TOPIC: Refused treatment in Alberta Canada


Guru

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RE: Refused treatment in Alberta Canada
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Hello again medo,

As I mentioned with your first post tonight, please contact ( Tig  ) for permission first. I would suggest you delete your posts until you verify if solicitation will be allowed.

Thank you. C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 63 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)



Senior Member

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Sorry to hear about this.

Logically, you would think that the best time to treat HCV as when it's diagnosed, and before more damage occurs.
Kaiser in Northern California diagnosed me, and fasttracked me in to treatment, even though I was F0-F1, with normal ALT/AST results, with 5.7 million VLC.

It's a shame when insurance companies get involved in any healthcare decision. Corporations exist only to make a profit for shareholders, only.



-- Edited by LamontCranston on Wednesday 22nd of November 2017 05:39:33 PM

__________________

Lamont Cranston "Only the Shadow knows."

65 years old, retired IT Network support 29 continuous sobriety in AA, ,DX'd in '99 with MS, DX'd with HCV 2, 2b , F0-F1 3/17/2017 VL 5.7m Starting EPCLUSA 7/28/17

No Virus Detected on November 20, 2017 3 months after EOT



Guru

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Hey there fellow canuck Greg!

Nice of you to be trying to suss what the problem may be for your friend in Alberta who is not being offered "covered" treatment.

You are right, she should come here.

Can't begin to figure out what the actual problem could be, given the lack of info/hx you have been given to work with.

Yes, if she is "able", if she capable, has the thorough persistence/stick-with-it-ness to figure out her way(s) past what ever obstacle she has run into, she will eventually get her treatment, and at F2, I hope sooner than later.

Yes, she should/could go see another/other doc(s), if she thinks docs are her problem - was she refused by a specialist? Perhaps she is being restricted somehow via the system (the "fine-print" of her coverage), queuing (who is sicker than she is, goes first) - the stupid "gotta be more than F2" was supposed to be going out the window, but who knows!, or, maybe they think she is having or will have a compliance issue of some type - (from here) it is pretty hard to figure out whereabouts her stick-wickets are that need to be sussed/solved. We are kinda at a deficit of info to know (identify) WHAT (if any) her particular obstacles are. We would have to be able to suss out what her specific obstacle is, to be able to know how to battle it.

Us canucks know, but others out of country might not, that every Province in Canada is a whole new dif world (just about) when it comes to each Provinces own medical system. It can be quite different for me in BC than it is for your freind in Alberta. Health systems (across every dif Province in Canada) all differ somewhat. At best, all of them can be gangly to access, difficult to understand at times, even for the medical professionals using the health systems, let alone the patients!

My experience with the BC medical system, (which I have found to be difficult to access, limiting, limited and disappointing) and Alberta's system may have some similarities. Each Province does re-invent themselves tho as far as medical services, basically a whole new ball of wax whatever Province you live in.

Rumour has it that health care coverage is better in Alberta than some other Provinces - it is bragged about that in Alberta one pays nothing or little for your "plan" and paying nothing or little "for drugs" - I would not be surprized if it does not always work out the way one has heard, is hoped for or is expected! Whatever Province you are in and whatever "plan" you have, there can exist multiple levels of obstacles and restrictions (in the fine-print!) that people do not run into until you are there, needing treatment or drugs.

It is work to figure out your Provinces medical services sometimes.

I just googled a quick look about Alberta's plan ... people who are enrolled in the "Alberta Adult Health Benefit" (AAHB) you mentioned, get 2 forms of "Drug Products" covered (all handled via Blue Cross?). The drugs "covered" are shown in 2 lists: (1) the "Drug Benefit List" (DBL), and (2) the "Drug Benefit Supplement" (DBS) - it could be that ... "only" a specialist, (might?) have to apply for HCV anti-viral drugs for your friend, by "only" using a "Special Authorization Request Form", maybe (only maybe) that might be the problem? - no idea! Something is definitely out of wack if she is being told she can't have treatment (or that she has to pay full price for it) - if one cannot afford to pay full price then it is the same thing as being told she can't have treatment! - she has to identify what the exact obstacle is.

 

I think this is a current "Special Author. Request Form" ... 

antivirals for chronic hepatitis c special ... - Alberta Blue Cross

https://www.ab.bluecross.ca/dbl/pdfs/60022.pdf

 

  

HCV anti-viral drugs are listed on the Alberta "DBL" (in a quick look I noted: inteferon, riba, simi, dacla, holkira, harvoni, even epclusa (and probably a couple more), so they ARE listed.    

This excerpt is from a "Catie" article (regarding HCV treatment in Alberta) and is likely as old as 2014?, so things "may" be a fair bit dif (now), links may be old and they maybe don't open??, but I'll include it anyway:

 

Some of the factors that may be considered when approving funding for these hepatitis C medications include:

·         a positive HCV RNA test

·         HCV genotype

·         level of fibrosis

·         previous experience with treatment

In Alberta, a person needs to have a certain level of liver injury (fibrosis stage 2) to qualify for treatment coverage. However, a person does not need to meet this requirement if they have one or more of the following issues:

·         Coinfection with HIV or hepatitis B

·         Fatty liver disease

·         Has previously had an organ transplant

·         other health problems caused by hepatitis C that affect parts of the body other than the liver (extra-hepatic manifestations)

·         Chronic kidney disease (stage 3, 4 or 5)

·         Diabetes and receiving treatment anti-diabetic mediations

·         Are of child bearing age and are planning to get pregnant within the next 12 months

These hepatitis C medications require special authorization  before they can be covered. To apply for approval people can request that their specialist complete and submit the Antivirals for Chronic Hepatitis C Special Authorization Request Form (ABC 60022)  for the medication they want to take and send it to Alberta Blue Cross for review against the Special Authorization Guidelines. The request will be evaluated to determine if a person's hepatitis C medications will be covered through their drug plan.

If people would like more information about health care or drug plans in Alberta, they can contact the Alberta Health Care Insurance Program (AHCIP) toll-free at 310-0000 then dial (780) 427-1432.

 

What GT is she Greg, how long has she had it, and what method(s) did they use to assess her at being F2?. C.

 

 

 



-- Edited by Canuck on Monday 20th of November 2017 11:41:11 PM

__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 63 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)



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Hi Greg,

Each province has their own criteria. But youd think stage 2 *should* get her treatment, I had to jump a lot of hoops in BC and had to register for a medicine assistance program as well as  get Abbie to co-pay. Although my Dr wanted me to do harvoni he also wanted me to do 12 weeks of meds, BC assist would only pay for 8 weeks harvoni so we went to Abbie and I got the Holkira Pak for the 12.

Do you know if she is seeing a hep specialist? If it was her family Dr, they might not have the same pull or the knowledge of the ins and out of buerocratic bs.

Ill do some googling and see if I can find out anything about Albertas system.

edit: okay if she is low income she should be able to get help... I found this website

http://www.catie.ca/en/practical-guides/hepc-in-depth/treatment/treatment-coverage-your-region/alberta

Alison



-- Edited by Observer on Monday 20th of November 2017 05:46:48 AM



-- Edited by Observer on Monday 20th of November 2017 05:52:13 AM

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60y/o, Infected via transfusion Oct'83, GT-1a, F-4 cirrhotic,
tx Holkira pak/moderiba 12 weeks

2.5years...post tx... successful dragon slayer 

Tig


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Hi Greg,

Good to hear from you, although the question is distressing. Sounds like your friend is getting a raw and unfair deal. We have some people in the know here that can respond with Canadian health care facts better than I. I find it very peculiar that she was given a denial straight away like that. I had been hearing access to care was getting easier there. These kinds of stories really irritate me. I would certainly be interested to know the justification her doctor gave her for the denial. 

As soon as Canuck and Obs read your post and respond, we can then try to brainstorm a plan for your friend. Lets put our heads together and get the train headed in her direction. I hope we can get her some direction soon. Nobody should have to hear that response from their doctor. I'm from the school that taught me, if you have HCV, you should be able to trea it, asap. The days of having to wait should be behind us. Looks like someone missed that memo...

At the least she should seek another opinion. Maybe her current doctor isn't qualified to make this decision or isn't fully schooled on treatment protocol. Whatever the case, I hope we can help.



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Tig

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

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Hi Everyone,

A friend in Alberta Canada has hep c, stage 2 fibrosis, and has been told by her doctor that AAHB (Alberta Adult Health Benefits) will not cover treatment for her. The doctor added that she would have to pay the 60k out of pocket, which she cannot afford. She is not on social assistance (welfare) but may soon be. I wonder if her chances to access treatment would be better if she was or perhaps she needs to get a new doctor who will prescribe the medication??

Would anyone have thoughts, comments or experience on this?

I have told her about this most excellent forum but, to my knowledge, has not joined.

Thank you.



__________________

60 yo, genotype 2b, started 28 week tx Sept.14, 2013. Triple Therapy (ribavirin, victrelis, peginterferon), VL 235k prior to tx, UND right through. EOT March 29, 2014. EOT24 Sept. 15, 2014 and EOT + ONE YEAR April 1, 2015 UND.... SVR!

 

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