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Hep C Discussion Forum -> General Discussion -> Harvoni approved for 24 weeks!?
Post Info TOPIC: Harvoni approved for 24 weeks!?
Miss B


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RE: Harvoni approved for 24 weeks!?
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Michaele & Lowrider,

Congratualtions on being approved! I see SVR in your future smile



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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!  
Michaele


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Hi I have been approved for 12 wks of Harvoni, but doctor wont treat until the pancreatic issue is resolved. The NP Nell said the approval can be extended until we can treat. So now that the wating is over the waiting begins again, wont know results until 12/2, if  its negitive my Hep c doctor needs statements from other 2 dr.s. Then I can begin. The pharm made sure to say I am responsible for any cost not covered by part D.  Hope every one remains hopeful, it took me a yr, but I did get approved.  Michaele



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Isiscat2011


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Hi Matt:

Just some of the usual delays.  First, my doc's office didn't send over enough information.  Then, on November 1, the pharmacy that was handling it changed. Last week my claim was lost in some black hole.  (Astronauts managed to retrieve it smile)  The insurance company claimed they had not received it.  Now, the insurance co wants to talk with my doc.  Probably more missing information.  

It could be that they want more recent blood work (makes no sense but a possibility).  My doc was planning to do bloodwork as soon as I am approved to get some baselines.  I have full blood work done every 6 months and the last draw was in June, 2014.  But, this is just speculation, and I'm not trying to guess.  I'll find out more this week.  

I have spent very little time on the phone so far but I expect that will change if substantive obstacles arise.  I'm not real happy about my doc's office level of preparedness or enthusiasm either but hopefully they will get the job done.  So, still waiting and trying to stay chill.  

Tomorrow will be 4 weeks since my doc appointment and I expected it could take that longer, or possibly longer.  As long as I get my approval before Abbvie comes to town I'm good with it (which should be Dec 21).



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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Matt Chris


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Hey Isiscat

Where are you at with your Harvoni request? Did I miss the good news?

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! 
Isiscat2011


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Tig56 wrote:

These denials are out of control!

There is actually a method to this madness and most payers are applying similar rules and strategies.  Lowrider was denied Sovaldi because the Sovaldi and Olysio combo was not FDA approved.  Once Harvoni was FDA approved so was his claim.  He is in the F-3-F-4 category so his tx is considered "urgent" under the AASLD guidelines.

F-3 and F-4s (who have not had prior all oral or Sovaldi tx) are being approved across the board, although the process is convoluted, and delay tactics are probably being employed.  As far as I know we have seen only two denials of cirrhotics here and both had prior all oral DAA tx: Greg and Matt.  Greg then prevailed on appeal and Matt is awaiting a decision.  

It is possible denials of cirrhotics will occur simply because of a "procedural" issue, such as the doctor's office not providing enough up to date documentation, but even those situations appear to be resulting in delays rather than denials.

F-0 through F-2s are being denied across the board; there may be an exception here and there for payers who have not yet invoked the AASLD priority guidelines.  

This is what appears to be happening if you analyze it.  The denials and approvals are fairly predictable.  



-- Edited by Isiscat2011 on Monday 17th of November 2014 04:38:11 AM

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Diagnosed in 2011, Incivek triple in 2011, tx discontinued, Genotype 1a, CT, VL 7mill, cirrhosis dx in 2012, age 67, waiting for new DAAs.
Matt Chris


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Hey Mark

Thats music to my ears, "Approved for 24 months" I think I'm going to write a song with that as a lyric. Maybe your doc signed you up with Gilead's Support Path if that's the case, you deserve every weeks worth. However it was accomplished thank your Doctor and your persistence. With us F4's cirrhotics we should not give up because we are in most need.

Hoping all go's well from here.

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! 
Tig


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Congrats on getting approved! If you learn something that could benefit the group, it would be much appreciated. These denials are out of control! Keep in touch and good luck getting things squared away this week.

Tig



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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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Lowrider


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I post here infrequently but have described being turned down for Sovaldi several times by my insurer, the latest was a week ago. I made an appeal to the Calif. State Medical Review Board without success after the second denial. Yesterday I received a letter of authorization for 24 weeks of Harvoni. Kind of dumbfounded to say the least. The health care insurer is a county employees benefit program which does not participate with Part D drug coverage. I am on Medicare. The doctor said he was working on something but didn't say what last week. So tomorrow I will call and find out the particulars. I am very happy but also mystified.

 

 Genotype 1A, Undetected at 8 weeks with 28 week PEG/Victrellis/Riba regimen but relapsed at 6 months post treatment. Ultrasound 6 months ago was negative for liver changes. Fibrosure score was .85 F4 Cirrhosis/Necroinflamat Grade A3 severe activity, GGT 119, ALT 88. Viral load is typically borderline High. 68 years old.



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"You can't count the miles until you feel them." T Van Zandt

68 yrs old, HepC 1A, relapsed 6 months post Victrelis/Interferon/Riba. Fibrosure F4 currently using Harvoni
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