Hep C Discussion Forum

Btw John:  You probably already got this but I do not agree at all that you should wait to address this issue.  And, as far as diplomacy is concerned, where your health is concerned diplomacy may have to take a second seat.  People who don't have cirrhosis may not understand the urgency to clear the virus.  

You can make your point without being rude but when your health is at stake who cares about your doctor saving face or getting her ego bruised?  If it is between her face and your a**, well, you know which one to save.  

Miss B wrote:

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Since you are in an HMO, the dr. is your advocate but is also the $employee$ of the HMO & sometimes I wonder if that limits how much they are willing to push to get their patients what they need?  

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Interesting point.  Under their own rules of professional conduct who they work for should have no bearing on their medical decisions for their patients. When they violate ethical rules and/or breach the standard of care they can be held individually liable.  

In reality, most now work for huge medical corporations and/or HMOs and this creates huge potential conflicts of interest.  Throw in some of their relationships with the pharma and insurance industries and you have a big old conflict of interest mess just waiting to happen. 

One other thing I wanted to say about 12 vs 24 weeks.  There are some docs who actually prefer 12 weeks not only for cost containment reasons but because they believe 24 weeks will result in overtreating the majority of patients.  This point of view is not without merit because if ~85% will SVR in 12 weeks then ~85% would be overtreated at 24 weeks.  Given that long term tx effects are not yet known that is not an unreasonable position.  OTOH, it might be better to overtreat all cirrhotics rather than potentially undertreat some; they have too much to lose if undertreated.  Opinions?

P.S.  During the AASLD seminar last week the docs were polled on tx protocols/durations for hypothetical patients.  ~ 1/3 of them--hepatologists in clinical practice--got the wrong answer for most questions!   Can you even believe that?  

John, please listen to the advice of Isis and Ro.  Being cirrhotic 24 weeks helps to assure success.  As Isis said, take the Harvoni prescribing label and Ion 2 study results.  Plead if necessary.  We both know there are NO guarantees.  It only makes sense to try and get the most effective treatment possible .  Good luck.

John, one other thought.  Most doc's have a very good idea of what the insurance company will approve.  If the doc has a reasonable certainty the insurance won't approve more than 12 weeks that may be part of his/her reasoning.

John:

I'm just going to be blunt here.  You have been through too many failed treatments and had too much crappy medical advice already.  If your doc only writes the script for 12 weeks it isn't going to be approved for 24.  Your protocol is for 24 weeks.  Call her office immediately before they send the pre-authorization paperwork in and tell them to correct this. 

She offered me 12 with Ribravirin today

JLynch30 wrote:

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Go in for blood tests today and then the doctor will order it.  Anyone know how long it takes after bloodtests for doctor to call int eh prescription?  They couldn't give me an exact time.  Any cirrhotics getting 12 weeks or is it all 24?

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Hi John:

It could be a couple of weeks or it could be a couple of months.  It isn't as easy as the doc calling it in.  It must go through the pre-authorization process and there are any number of ways it can be delayed.  Based on your prior Sovaldi experience it could potentially even be denied and you will need to go through the appeal process.  While I would expect you will eventually get it please be prepared for some obstacles.  If you get it fast, great, but that isn't happening often.  Tx experienced cirrhotics should be approved for 24 weeks pursuant to Gilead's own labeling which was FDA approved.