Harvoni approved by Cigna, Aetna, BlueCross, United healthcare
Sierrajen said
Nov 10, 2014
Boy I hear you Tig. I have had joint pain for more than 25 years and I was way to young to have arthritis . I hadn't had THAT much fun yet. so all the test just indicate a low low level of osteoarthritis and heres your Ibuprofen. well that low level OA has put me in a wheel chair on and off crutches and basically made me walk limp for years. Oh and then I'd be fine for awhile . wth! so I think they just thought I was a hypochondriac. I even wondered. now I am feeling there might be a light at the end of the tunnel.
I met a lady that had a liver transplant and all of her joint pain went away. wow. sign me up. come on Mr Harvoni. make it so!
HERE IS SOMETHING THAT JUST POSTED TODAY.... AASLD'S LATEST GUIDELINES - I JUST READ & THEY ARE INCLUDING THOSE WITH "EXTRAHEPATIC MANIFESTATIONS" AS PRIORITY PATIENTS. (AROUND PG 42)
I LOOKED THAT UP - IN THE SAME DOCUMENT & THAT MEANS BASICALLY OTHER ILLNESS YOU HAVE THAT MAY BE A RESULT OF HEPC BUT YOU HAVE BEEN DIAGNOSED WITH SUCH AS : DEBILITATING FATIGUE, JOINT PAIN, MYALGIA (MUSCLE PAIN), DRY EYES & MOUTH, COPD. I PERSONALLY HAVE BEEN DIAGNOSED WITH EVERY ONE OF THOSE. I DON'T RECALL SEEING THAT BEFORE BUT IF IT WAS IN THERE BEFORE, MY DR SHOULD HAVE KNOWN WHAT THAT MEANT & USED IT IN MY PRE-AUTH. HOWEVER THEY DO SPECIFICALLY NOTE: DEBILITATING FATIGUE & I DON'T RECALL SEEING THAT BEFORE; WHICH EXACTLY WHAT MY DR SAID THEY MIGHT ANNOUNCE AT TOMORROW'S CONFERENCE.
What good is a miracle drug if you cant afford it? So asks Dr. John D. Bennett, the President and CEO of Capital District Physicians Health Plan, in an article in the Albany Business Review. Its a question weve long been asking drugmakers, and like Dr. Bennnett, were still waiting for an answer.
Behind that question are six-figure prices for specialty pharmaceuticals unaffordable price tags set by drug companies preying on the wallets and emotions of patients who are desperate to find cures, according to Bennnett.
Then we have specialty drugs that treat hepatitis C most notably, Sovaldi and Harvoni at $1,000 and $1,125 a pop to demonstrate how the cost of life-saving medications has soared far out of reach for many patients. As Dr. Bennett puts it, We hoped for a day when miracle drugs like Sovaldi would cure hepatitis C. Now that were here, we must come together to make these drugs affordable, for everyone.
Health plans continue to focus on ensuring affordability and accessibility, echoing Dr. Bennetts call to find a sustainable pricing solution.
- See more at: http://www.ahipcoverage.com/2014/11/04/beware-a-handful-of-drugs-with-enormous-price-tags/#sthash.Hnwmqmps.dpuf
shadow10cats said
Nov 9, 2014
oh they included those too. well sort of; the parts that supported them. they conveniently left out all the rest - I especially love the part they left out where the AASLD says they are not happy that ins companies are using their guidelines as a means to deny.....
Here's what CDPHP said: Current treatment guidance from the American Association for the Study of Liver Diseases (AASLD) places the highest priority of treatment for hepatitis C among individuals who have fibrosis stages F3, F4, or in some cases of F2 with significant extrahepatic manifestations of chronic hepatitis C disease such as mixed cryoglobulinemia and vasculitis."
And the "latest" from AASLD:
The American Assoc for the Study of Liver Disease (AASLD) - Update to Recommendations for Testing, Managing, and Treating Hepatitis C: Management of Acute HCV Infection:
The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease.5 An estimated 180 million people are infected worldwide.6 In the United States (U.S.), the prevalence of HCV infection between the years 1999 and 2002 was 1.6%, equating to about 4.1 million persons positive for antibody to hepatitis C (anti-HCV), 80% of whom are estimated to be viremic.7 Hepatitis C is the principal cause of death from liver disease and the leading indication for liver transplantation in the U.S.8 Some calculations suggest that mortality related to HCV infection (death from liver failure or hepatocellular carcinoma) will continue to increase over the next two decades.
Our recent addition to the Guidance prepared by a committee of leading liver experts from AASLD and The Infectious Diseases Society of America (IDSA) proposed that the sickest patients be treated first, but all patients who receive advice from their doctor to take newest medications should not be denied. The decision across the board should be in the hands of the clinician and the patient to make the decision. Unfortunately payers across America are denying treatment when a doctor has prescribed it for their patient.. We adamantly disagree with this decision.
Our Guidance is not intended to be used by payers to deny access to treatment. In no way does this position contradict the evidence evaluated to produce the Guidance and the recommendation made in the Guidance to treat the sickest first, but recognizes need to treat all.
AASLD remains committed to its partnership with IDSA and to continuing to fund and write the practice Guidance. As the only organization solely dedicated to the prevention and cure of liver disease, we applaud the seminal research of our members who made recent treatment options possible. We are concerned about cost, but we also recognize the value of this drug to patients with hepatitis C. It's a one-time treatment, with minimal side effects and a great cure rate.
if it turns out i have to appeal my initial denied pre-auth i will be sure to throw that right back at em. (for those who haven't read the other thread there's a conference in boston monday. the AASLD may again revise their guidelines & there is a push to have them add "severe chronic fatigue" - if they do, I have actually been tested & diagnosed w/ that) We will see...............
Sierrajen said
Nov 9, 2014
I am curious . is Harvoni for geno types 1a and 1b?. I It is very good new that the other insurance companies are going to Add Harvoni to their list of approved drugs.
Miss B said
Nov 8, 2014
"Not medically necessary" is an ignorant statement. It sounds like they just chose the denial response du jour. They might want to read the AASLD guidelines for treatment & benefits of treatment.
-- Edited by Miss B on Sunday 9th of November 2014 03:25:41 AM
shadow10cats said
Nov 8, 2014
I would rather an insurance company be honest and say they can't afford to give this out to everyone all at once so they are prioritizing & giving to those most ill first. I understand that but to just lie or make crap up; that ticks me off or deny someone based on something like " the drug is not medically necessary" - I passed that one along to Gilead. I mean heck if Harvoni isn't medically necessary they sure could have saved a lot of money developing it!
Miss B said
Nov 6, 2014
My doctor at Kaiser Permanente called today to say that they will follow the AASLD guidelines of treating F3/F4/cirrhotic/transplant patients first (as in now). They are asking all others to wait until the price comes down. They are hoping the Abbvie & others near approval will force Gilead to lower the price of Harvoni.
Miss B said
Oct 31, 2014
I called Kaiser Permanente today and was told that Harvoni has now been added to their formulary in all regions.
The person I spoke with didn't know anything about criteria for qualifying.
Miss B said
Oct 23, 2014
Thanks for gathering that info about the insurers who are on board with treatment. I met with my dr. last week & he had no idea what Kaiser's criteria would be for Harvoni. I told him that was surprising considering Sovaldi has been approved since 12/13 & Gilead filed for FDA approval for Harvoni in 2/14.
Huey said
Oct 23, 2014
pushed the like button
Fireman Rob said
Oct 23, 2014
This is good news but I have my doubts United Healthcare has no restrictions on these meds and no fibrosis level requirement. They wouldn't cover Sovaldi for me in April. Hopefully that changes sooner than later for Harvoni.
-Rob
Tig said
Oct 23, 2014
That's good news! I'm glad that we're seeing more and more insurance carriers getting on board and adding these drugs to their formularies. We may see some dragging their feet until after the first of the year, but they are all going to be under pressure to start providing decisions one way or another. Your doctor will be the one that determines what the qualifiers will be. Certainly levels of fibrosis will be on top, along with previous treatment experience and current health. I'm sure there will be a lot of wait and see what the others are doing as well. But the good thing is, it has started moving forward!!
Tig
angelseven said
Oct 23, 2014
OK, called cigna today and Harvoni has been added to their formulary with pre-approval, she only said preapproval required degree of fibrosis, liver biopsy, and some other things, you have to meet certain criteria but it did not list the exact criteria or fibrosis level... she had no link for their document... so will just have to see how it goes...
So now, United Healthcare, Aetna, Blue cross Blue shield have Harvoni available... United healthcare has no specific criteria regarding fibrosis level although Blue Cross blue shield does....
Peace, angelseven
-- Edited by angelseven on Thursday 23rd of October 2014 10:38:29 PM
Boy I hear you Tig. I have had joint pain for more than 25 years and I was way to young to have arthritis . I hadn't had THAT much fun yet. so all the test just indicate a low low level of osteoarthritis and heres your Ibuprofen. well that low level OA has put me in a wheel chair on and off crutches and basically made me walk limp for years. Oh and then I'd be fine for awhile . wth! so I think they just thought I was a hypochondriac. I even wondered. now I am feeling there might be a light at the end of the tunnel.
I met a lady that had a liver transplant and all of her joint pain went away. wow. sign me up. come on Mr Harvoni. make it so!
Hugs Jen.
Hi BJ,
Yep, we've talked about these issues time and again here. http://hepcfriends.activeboard.com/t58707382/extrahepatic-manifestations-of-hcv/ It would be nice to be heard and not simply listened to by many of our doctors. Just keep on them, sounds like they're starting to actually pay attention! One of these days....
Tig
HERE IS SOMETHING THAT JUST POSTED TODAY.... AASLD'S LATEST GUIDELINES - I JUST READ & THEY ARE INCLUDING THOSE WITH "EXTRAHEPATIC MANIFESTATIONS" AS PRIORITY PATIENTS. (AROUND PG 42)
I LOOKED THAT UP - IN THE SAME DOCUMENT & THAT MEANS BASICALLY OTHER ILLNESS YOU HAVE THAT MAY BE A RESULT OF HEPC BUT YOU HAVE BEEN DIAGNOSED WITH SUCH AS : DEBILITATING FATIGUE, JOINT PAIN, MYALGIA (MUSCLE PAIN), DRY EYES & MOUTH, COPD. I PERSONALLY HAVE BEEN DIAGNOSED WITH EVERY ONE OF THOSE. I DON'T RECALL SEEING THAT BEFORE BUT IF IT WAS IN THERE BEFORE, MY DR SHOULD HAVE KNOWN WHAT THAT MEANT & USED IT IN MY PRE-AUTH. HOWEVER THEY DO SPECIFICALLY NOTE: DEBILITATING FATIGUE & I DON'T RECALL SEEING THAT BEFORE; WHICH EXACTLY WHAT MY DR SAID THEY MIGHT ANNOUNCE AT TOMORROW'S CONFERENCE.
http://www.hcvadvocate.org/hepatitis/factsheets_pdf/AASLD_HCVGuidelines_2014.pdf
Hi Jen,
Yes, Harvoni is recommended for Genotype 1 a/b. Here's a recent discussion and a link for the Harvoni monograph that we had on the forum:
http://hepcfriends.activeboard.com/t58859370/harvoni-monograph/?page=1#comment-58859370
Tig
i just now did a search on harvoni and cdphp and found this posted just a few days ago by the ceo of cdphp:
Beware: A handful of drugs with enormous price tags
What good is a miracle drug if you cant afford it? So asks Dr. John D. Bennett, the President and CEO of Capital District Physicians Health Plan, in an article in the Albany Business Review. Its a question weve long been asking drugmakers, and like Dr. Bennnett, were still waiting for an answer.
Behind that question are six-figure prices for specialty pharmaceuticals unaffordable price tags set by drug companies preying on the wallets and emotions of patients who are desperate to find cures, according to Bennnett.
To see how a handful of drugs could bankrupt the entire U.S. health care system, look no further than oncology treatments, whose prices jumped by 10.6 percent in 2013 alone. Add to that the fact that more than 1,000 cancer drugs are under development and most of those treatments will cost a patient more than $120,000 a year. And even more troubling, those astronomical price tags extend to older cancer therapies as well. Many of these drugs offer great promise for patients, but their prices threaten access to them.
Then we have specialty drugs that treat hepatitis C most notably, Sovaldi and Harvoni at $1,000 and $1,125 a pop to demonstrate how the cost of life-saving medications has soared far out of reach for many patients. As Dr. Bennett puts it, We hoped for a day when miracle drugs like Sovaldi would cure hepatitis C. Now that were here, we must come together to make these drugs affordable, for everyone.
Health plans continue to focus on ensuring affordability and accessibility, echoing Dr. Bennetts call to find a sustainable pricing solution.
- See more at: http://www.ahipcoverage.com/2014/11/04/beware-a-handful-of-drugs-with-enormous-price-tags/#sthash.Hnwmqmps.dpuf
oh they included those too. well sort of; the parts that supported them. they conveniently left out all the rest - I especially love the part they left out where the AASLD says they are not happy that ins companies are using their guidelines as a means to deny.....
Here's what CDPHP said: Current treatment guidance from the American Association for the Study of Liver Diseases (AASLD) places the highest priority of treatment for hepatitis C among individuals who have fibrosis stages F3, F4, or in some cases of F2 with significant extrahepatic manifestations of chronic hepatitis C disease such as mixed cryoglobulinemia and vasculitis."
And the "latest" from AASLD:
The American Assoc for the Study of Liver Disease (AASLD) - Update to Recommendations for Testing, Managing, and Treating Hepatitis C: Management of Acute HCV Infection:
The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease.5 An estimated 180 million people are infected worldwide.6 In the United States (U.S.), the prevalence of HCV infection between the years 1999 and 2002 was 1.6%, equating to about 4.1 million persons positive for antibody to hepatitis C (anti-HCV), 80% of whom are estimated to be viremic.7 Hepatitis C is the principal cause of death from liver disease and the leading indication for liver transplantation in the U.S.8 Some calculations suggest that mortality related to HCV infection (death from liver failure or hepatocellular carcinoma) will continue to increase over the next two decades.
Our recent addition to the Guidance prepared by a committee of leading liver experts from AASLD and The Infectious Diseases Society of America (IDSA) proposed that the sickest patients be treated first, but all patients who receive advice from their doctor to take newest medications should not be denied. The decision across the board should be in the hands of the clinician and the patient to make the decision. Unfortunately payers across America are denying treatment when a doctor has prescribed it for their patient.. We adamantly disagree with this decision.
Our Guidance is not intended to be used by payers to deny access to treatment. In no way does this position contradict the evidence evaluated to produce the Guidance and the recommendation made in the Guidance to treat the sickest first, but recognizes need to treat all.
AASLD remains committed to its partnership with IDSA and to continuing to fund and write the practice Guidance. As the only organization solely dedicated to the prevention and cure of liver disease, we applaud the seminal research of our members who made recent treatment options possible. We are concerned about cost, but we also recognize the value of this drug to patients with hepatitis C. It's a one-time treatment, with minimal side effects and a great cure rate.
if it turns out i have to appeal my initial denied pre-auth i will be sure to throw that right back at em. (for those who haven't read the other thread there's a conference in boston monday. the AASLD may again revise their guidelines & there is a push to have them add "severe chronic fatigue" - if they do, I have actually been tested & diagnosed w/ that) We will see...............
I am curious . is Harvoni for geno types 1a and 1b?. I It is very good new that the other insurance companies are going to Add Harvoni to their list of approved drugs.
"Not medically necessary" is an ignorant statement. It sounds like they just chose the denial response du jour. They might want to read the AASLD guidelines for treatment & benefits of treatment.
-- Edited by Miss B on Sunday 9th of November 2014 03:25:41 AM
I would rather an insurance company be honest and say they can't afford to give this out to everyone all at once so they are prioritizing & giving to those most ill first. I understand that but to just lie or make crap up; that ticks me off or deny someone based on something like " the drug is not medically necessary" - I passed that one along to Gilead. I mean heck if Harvoni isn't medically necessary they sure could have saved a lot of money developing it!
My doctor at Kaiser Permanente called today to say that they will follow the AASLD guidelines of treating F3/F4/cirrhotic/transplant patients first (as in now). They are asking all others to wait until the price comes down. They are hoping the Abbvie & others near approval will force Gilead to lower the price of Harvoni.
I called Kaiser Permanente today and was told that Harvoni has now been added to their formulary in all regions.
The person I spoke with didn't know anything about criteria for qualifying.
Thanks for gathering that info about the insurers who are on board with treatment. I met with my dr. last week & he had no idea what Kaiser's criteria would be for Harvoni. I told him that was surprising considering Sovaldi has been approved since 12/13 & Gilead filed for FDA approval for Harvoni in 2/14.
pushed the like button
This is good news but I have my doubts United Healthcare has no restrictions on these meds and no fibrosis level requirement. They wouldn't cover Sovaldi for me in April. Hopefully that changes sooner than later for Harvoni.
-Rob
That's good news! I'm glad that we're seeing more and more insurance carriers getting on board and adding these drugs to their formularies. We may see some dragging their feet until after the first of the year, but they are all going to be under pressure to start providing decisions one way or another. Your doctor will be the one that determines what the qualifiers will be. Certainly levels of fibrosis will be on top, along with previous treatment experience and current health. I'm sure there will be a lot of wait and see what the others are doing as well. But the good thing is, it has started moving forward!!
Tig
OK, called cigna today and Harvoni has been added to their formulary with pre-approval, she only said preapproval required degree of fibrosis, liver biopsy, and some other things, you have to meet certain criteria but it did not list the exact criteria or fibrosis level... she had no link for their document... so will just have to see how it goes...
So now, United Healthcare, Aetna, Blue cross Blue shield have Harvoni available... United healthcare has no specific criteria regarding fibrosis level although Blue Cross blue shield does....
Peace, angelseven
-- Edited by angelseven on Thursday 23rd of October 2014 10:38:29 PM