Hep C Discussion Forum

Am I worth it?  Here goes a new adventure - have beat death one time with a kidney transplant - hopefully I have nine lives......

thanks much for the research Tig - I did a bit more last night and my data agrees with yours.   Seems there have been about 40 liver transplant patients but no Kidney!   Looks like I am the guinea pig.   They are going to double the number of usual labs to watch for anemia - which they believe to be the biggest risk.  My kidney dr is also very interested and has scheduled more appts/labs with him - he was unaware of the drug before this.   I just don't want to lose the kidney - it was my wife's and I have had it for almost 14 yrs ....and dialysis is a helluva way to live - done that for 13 months.

OK, so went to the Doctor today with the insurance letter - they are now processing the prescription through a speciality pharmacy and have assigned a consultant to me.  Both the Riba and the Sovaldi are coming from same pharm - may take up to three weeks.   The Doctors said they are spending a lot of time working with the insurance companies on this drug.   I was told that I was the only one that had a kidney transplant that has tried Sovaldi - I am not sure I believe this - will research it but appreciate any help here.....also believe they will start me lower than 600mg riba because of the transplant.

Got a letter from BCBS Insurance today authorizing the treatment with Sovaldi - took a bit more than three weeks.   I have never got a letter from an insurance company before on any prescription so they certainly are treating this differently.

Gilead is committed to ensuring that people with hepatitis C can access Sovaldi and has launched Support Path (www.MySupportPath.com) to provide assistance to patients who are uninsured, underinsured or who need financial assistance to pay for the medicine. The program consists of an integrated offering of support services for patients and providers, including:

• Access to dedicated case managers to help patients and their providers with insurance-related needs, including identifying alternative coverage options such as federally-insured programs (e.g., Medicaid, Medicare) and health exchanges.
• Education and support, including a 24/7 nursing support service line and the ability to schedule an onsite visit from a clinical educator.
• The Sovaldi Co-pay Coupon Program, which provides co-pay assistance for eligible patients with private insurance who need assistance paying for out-of-pocket medication costs. Most patients will pay no more than $5 per co-pay. Co-pay assistance can also be applied toward deductibles and co-insurance obligations.
• Gilead will provide support to the Patient Access Network (PAN) Foundation, an independent non-profit organization that provides assistance for eligible federally-insured and privately-insured patients who need help covering out-of-pocket medication costs.
• The Support Path Patient Assistance Program will provide Sovaldi at no charge for eligible patients with no other insurance options.

Information about how to apply for any of these forms of assistance can be found at www.MySupportPath.com or by calling 1-855-7MyPath (1-855-769-7284) between 9 a.m. - 8 p.m. EST.

- See more at: http://hepatitiscresearchandnewsupdates.blogspot.com/2013/12/patient-assistance-for-sovaldi.html#sthash.cpG68B5A.dpuf

I am currently pending approval for Sovaldi through BCBS AZ.  My understanding is that each request is reviewed independently including a peer review between your Doctor and BCBS doctor.   The process has gone on for three weeks as of now.   BTW, the cost climbs to ~200K if your are Genotype 3 because you need 6 months treatment.   Am very worried because other treatment options can result in my kidney transplant failing.   I also wonder what the insurance companies are going to do with patients who can use other treatments but are having issues with the side effects?

As a newbie to the new drugs (Sovaldi and Olysio) with Riba, and a new Blue Cross (the new Community Blue plan) USA policy holder, the insurance process was not that bad. 

My doctor applied for the medications and because what she wanted me to take was considered "off label"  ( because FDA had not approved of the combo usage) it was denied. My doctor had to have a phone call with a BlueCross management person in a appeal process and then it was approved.  My guess is the decision was made to approve the new Hep C treatment based on individual FDA approval and the SVR results versus ant alternative HCV treatment cost. 

My health insurance plan is a group plan obtained through a work benefit as opposed to a individual plan.  A group plan cannot be cancel or have coverage cancelled due to pre existing conditions. 

The employer can increase the employee cost or change the employee deductibles at plan renewal time based on the new cost of the plan.  Right now we have a $5,000 deductible per person or $10,000 max deductible out of pocket expense per family each year. The monthly cost for the family coverage is $490 a month. Over the last 4 years the monthly cost has increased and the deductibles have also.  Seems like a lot of money each month and for many years we never had a claim until this year. 

With my diagnosis of HEP C GT 1 and cirrhosis level 5,  the cost over a 7 month time frame to get to this point from all the doctors, exams, biopsy, cat scans, blood work has had me hit the $10,000 deductible limit.

When Bluecross approved the HCV treatment and I found out my co-pay for medications was $495 a month and they are picking up over $50,000 a month for 3 to 6 months, I was ecstatic ! 

If my monthly cost doubles or triples at renewal time, I will still be ahead of the game.  

I think it remains to be seen, especially here in the USA. I've already had two insurance policies cancelled because of the new ACA (O-Care). My Rx costs went from affordable and comprehensive coverage with no limits, to almost nothing worthwhile and I've lost all my doctors. It sucks, big time. There is such an out-roar going on now about the prohibitive costs, I think we've yet to hear the end of it. It looks like they'll have to cover the costs because Big O said so. But it's going to cost every patient a large deductible and monthly premium that many won't be able to afford before first being eligible for insurance payment assistance. It's all going to depend on this insurance fiasco and right now the people handling it aren't sure. So that kind of leaves us in the dark.