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Hep C Discussion Forum -> General Discussion -> It looks like United healthcare is on the job
Post Info TOPIC: It looks like United healthcare is on the job
Miss B


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RE: It looks like United healthcare is on the job
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JLynch, 

Thanks for posting the United Healthcare criteria.  They quote the AASLD guidelines of "When & In Whom to Treat."  I noticed both United Healthcare & Anthem/Express Scrips quote the AASLD guidelines but they only quote the part of the guidelines that suits their purposes.  They set their criteria to treat only F3/F4/cirrhosis based on AASLD guidelines. But what they omit is that AASLD says F3/F4/cirrhosis should be treated FIRST.  I think we can all agree on that.  What bothers me is they omit the following information where AASLD says ALL patients with HCV should be treated.  The insurance companies are really distorting the guidelines & it is important info to have if you need to file an appeal.

http://www.aasld.org/aboutus/publicpolicy/Pages/aasldhcvposition.aspx

"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."

AND

http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy

Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure, and as such, is expected to benefit nearly all chronically infected persons. Evidence clearly supports treatment in all HCV-infected persons, except those with limited life expectancy (less than 12 months) due to nonliver-related comorbid conditions (See Unique Patient Populations). Urgent initiation of treatment is recommended for some patients, such as those with advanced fibrosis or compensated cirrhosis (see Table 1).

 



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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!  
Matt Chris


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Bravo for United Healthcare

At least they are using well respected Liver health organizations for there basis and resource to figured out acceptable criteria for the latest treatments.

This is in great contrast to the lame and outright ignorance of BCBS, they have no clue of whats happening with new treatments.

matt 



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"And in the end, the love you take is equal to the love you make"

61 year old Geno type A1, F4 Cirrhotic, started 24 weeks on Harvoni 12-17-14 ,EOT-5 week = UND, 8-31-15 =UND , SVR-24 Baby YES! 
Michaele


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Thanks Tig, the Part D I have says not covered, but with the right paperwork and the need to treat it can be had, well thats what I've been told. But it could take a long time, and appeals .      Michaele

 



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Tig


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It's good to see it written down, as it should be, but it's distressing to see the restrictions. Why shouldn't all eligible genotypes, viral loads, fibrosis stages and people with a treatment history, etc., etc., be eligible from the start? I think the best criteria for eligibility would be,

(1) Do you have HCV?

(2) Do you want to treat?

(3) Do you have a qualifying Genotype?

(4) Congratulations, you qualify!

Tig  no

 

@Michaele, yes that's the same company. However, they have multiple policies and that includes formularies as well.



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Tig

68yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 9+ years!

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Michaele


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Hi, at the risk of sounding stupid, is that the same UnitedHealthcare that AARP part D is insured through? Michaele



-- Edited by Michaele on Thursday 30th of October 2014 08:35:02 PM



-- Edited by Michaele on Thursday 30th of October 2014 08:35:22 PM

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JLynch30


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https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Pharmacy%20Resources/Harvoni_Medical_Necessity.PDF



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John   non-responder  

Undetected at week 2 on solvaldi/rib/interferon:  stayed through week 12 but virus came back as soon as I stopped.  on   Harvoni and ribravirin 24 weeks undetected after two. 8/2/15  12 week EOT  UNDETECTED!  SVR

1991-2015 RIP

 
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