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Hep C Discussion Forum -> New Members Area -> new member: harvini appeal
Post Info TOPIC: new member: harvini appeal
LC


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RE: new member: harvini appeal
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Miss B wrote:

 

LC posted the link below to the article about Express Scripts battle with Gilead.  Clearly, they want to avoid/delay using Harvoni until they find out if they can save $ using the Abvie meds.

 

It would be hard to believe AbbVie's meds out-pricing Gilead's Harvoni.  They would have to be fools indeed, which I don't believe they are.  It the risk of sounding like a broken record, the AbbVie treatment isn't bad at all.  I know some of you had trouble tolerating prior treatments, and if you got anemic and broke out in bad rashes - no one can blame you for not wanting anything to do with Ribavirin.  I do wonder how much the Ribavirin's effects were exacerbated by the length of treatment or the Interferon that went with it.  confuse



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Genotype 1a, VL 1,151,923.  51 years old.  Started treatment on AbbVie TOPAZ II clinical trial Oct 10, 2014!  Undetected at weeks 2 and 4! 
Miss B


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In case you don't have it, I found the Anthem/Express Scripts Prior Authorization Form: http://www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf?na 

If this is the most recent Express Scripts form, #2 on page 3 does not reflect the most recent AASLD guidelines for treatment.

The updated AASLD guidelines for treatment are discussed on this thread: http://hepcfriends.activeboard.com/t58907648/denial-of-harvoni-the-dummies-guide-to-appeals/

LC posted the link below to the article about Express Scripts battle with Gilead.  Clearly, they want to avoid/delay using Harvoni until they find out if they can save $ using the Abvie meds.

 



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Miss B
56 years old. Genotype 1B, previous treatment with interferon 1994. Started Harvoni 12/8/14. After 2 weeks, VL dropped from over 4 million to 496. At 4 weeks, undetected, but at 8 weeks, <15 mL (detected), at 12 weeks/EOT UND!  
johnsshutts


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I am only between Stage 1 and 2, with a little scaring. I have to be between stage 3 and 4 for approval. According to the guidelines, my hep c is not severe enough to be approved for harvoni. You are right, this will eat you up, and consume all of your energy. It has done it for me, for over two weeks. I have done a lot of research, and spent numerous hours on the phone. I am going to be patient, and wait. 



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John Shutts
Groupergetter


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Good luck with this John.  I too have been dealing with Express Scripts trying to get the Harvoni approval.  I was passed around without getting much useful information. Have spent hours on the phone with them.  I recently filed an appeal.  Should know more this week.  Keep the faith, and try to stay positive.  I know how hard this can be.  Try and stay focused on the good things in your life, family, hobbies, pets, a short walk, whatever it may be that helps keep this off your mind.  You know your situation best.  While we need to be proactive. if we let this consume us or become obsessed with this, we tend to lose sight of the meaningful things in our lives.  Hug your wife, your child, your dog, or family member, you'll both feel better.   Things will work out.     



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1b  Int/Riba relapse @ 48 weeks.  Stop tx Peg Int/Riba 12 weeks ill. Relapse S/O 6/23/14 :(   Started Harvoni 11/12/14  EOT 4/28/15.  EOT+4 UND :)  SVR! 8/4/15  :)     Thankful for every morning.
Miss B


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I want to wish you good luck with the appeals process; I hope you will be approved this time.  Did they tell you specifically why you were denied? Knowing the particulars may help, so you can provide them with supporting information.  Do you have a copy of their Prior Authorization form for Harvoni or any written criteria for treatment?  It's hard to know how to meet their guidelines for treatment if you don't know what they are.  You are entitled to know this information. 



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Miss B
56 years old. Genotype 1B, previous treatment with interferon 1994. Started Harvoni 12/8/14. After 2 weeks, VL dropped from over 4 million to 496. At 4 weeks, undetected, but at 8 weeks, <15 mL (detected), at 12 weeks/EOT UND!  
johnsshutts


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I did co-pegus (ribavirin) and pegasys (interferon) for 14 months, over 10 years.

 

   I thought my harvoni was going to be approved by Friday afternoon. I called GEHA, (First Health Network) (Express Scripts), every two hours on Friday. They told me the doctor is reviewing it, and he should finish anytime, I was very excited. Then Friday afternoon, I was told that my urgent appeal is being sent to an outside source for further review. The lady mentioned that it was being sent to MRI, whatever she meant by that? She didn't even know. The doctor said it needs further review to see if I meet the guidelines. What a kick in the butt, not excited no more. I called the pharmacist with Acaria, and he said this could be good or bad. This is where I am getting my medicine from, out of Houston, Tx.  I did let the appeals department know on Wednesday, that I am on The Family Medical Leave Act, and I miss a lot of work because of my hep c. I am very weak, achy, and tired a lot, ect. I also told them on Friday, that I work in a warehouse, for 9 years, and I get cut a lot, and I bleed a lot. I am afraid I am going to infect someone. It really scares me a lot. I don't want to infect no one. I should find out Tuesday if it gets approved, or not. My doctor wrote my prescription for harvoni on October 16th, 17 days ago. I will keep you all posted.



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John Shutts
LC


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You really don't want it to drag out with Express Scripts if you want Harvoni, they are on the news saying if AbbVie is cheaper, that's the treatment they prefer. Maybe they will make an exception for previous non-responders, I don't know.

www.fiercepharma.com/story/express-scripts-ready-favor-abbvie-hep-c-prospect-provided-it-undercuts-gil/2014-10-31

__________________

Genotype 1a, VL 1,151,923.  51 years old.  Started treatment on AbbVie TOPAZ II clinical trial Oct 10, 2014!  Undetected at weeks 2 and 4! 
robertsamx


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Hi John, welcome.14 months of peg.  Did you also do riba with the peg??   You said it messed you up, I did riba/sofosbuvir 16 weeks and I feel the riba really messed me up .All you all that did treatment  before the DAA"s are tough people.  We are luckey to be in USA. In Europ they will be 2.5 to 5 years before they get Harvini. Government and insurance in Europe is a few years behind us.  You need to keep the pressure on your insurance and keep pushing back to there denial.  Good luck  RC



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 M-68, 3 Treatments)( SOF-RIBA 2014)(SOF-RIBA-PEG 2016)(HCC 2016) (LIVER TRANSPLANT 8-2017)(VOSEVI-RIBA 2017)   SVR-12. 3-13-18   
johnsshutts


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Thanks for having me, everyone. My name is John Shutts fron Corpus Christi, Tx.

   I am calling my insurance today on my harvini appeal. I am going to tell them all of the severe symptoms I am having because of my chronic hep c disease. Just because I am between stage 1 and 2, with a little bit of scarring, doesn't mean I am not sick a lot. I was on peg and co-peg for 14 months, over 10 years ago, it really messed me up too. I haven't been myself after that long painful, and terrible treatment. I think it did a lot of damage to my body. 

   Express scripts denied my harvoni on the first day that my doctor sent my precription in to the pharmacist, on Fri., Oct. 17th. My appeal was faxed by my doctor on Thur., Oct. 23rd. I don't want this to drag out for a long time. I want to be on treatment and get cured of this terrible disease. We all have been waiting to long for new medicines that will cure us. I will keep you all posted on how long this appeal will take, and if it gets approved. You all have a great Monday, and a wonderful week.

 



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John Shutts
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