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Hep C Discussion Forum -> On Treatment -> Can Pharmacy overrule Prescription?
Post Info TOPIC: Can Pharmacy overrule Prescription?
Bills


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RE: Can Pharmacy overrule Prescription?
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We'll that wasn't bad they fixed it.  I did need to be re-assured  that they do have me down for 24 weeks. I really don't trust any of these insurance / pharmacy / drug companies. Nothing would surprise me so I got eyes wide open and always looking back.  



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Bills

Harvoni started 12-12-14 for 24 wks PrevTX Geno 1 stage 3 cirrhosis - non resp Int/ ribv. Started Trial  in Aug 2011 -July 2012 into Incivek relapsed  Feb 2013 Had 72 weeks on interferon & Riba.

Bills


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I'm glad i just happened to look in here

Thanks I'm 8 days till next bottle of Harvoni and you guys reminded me call it in

They just made me take a step back  she said I need to call in for approval

What? your packing slip reads I will get 24 weeks as in 5 refills left / then 4 refills left is there a problem?

I have Global Pharmacy as my scrip provider Prime Aid is the local specialty Pharmacy All together my treatments last 6 years has been just perfect. never been a hold up so this scared me a little  I hope it's just procedure to be sure I didn't have to stop TX. and looking to sell my pills. I'm not going to freak out just yet. 

I know 2 people Ive told to get on this form and get some help with your issues your having with doctors and insurance. 1. they aren't very computer literate 2. they trust in Gasto Drs with Hep C as a part of their practice. It seems to me the Gastro / Liver doctors may be able to treat but don't have the experience with insurance companies / prescription providers to get things done the way the research hospitals do. 

 We are not just fighting our HCV but the systems as well. I'm so greatful that all the gurus here have been putting so much effort into response and collection of resources for all of us  You guys are the best.

Bill S    



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Bills

Harvoni started 12-12-14 for 24 wks PrevTX Geno 1 stage 3 cirrhosis - non resp Int/ ribv. Started Trial  in Aug 2011 -July 2012 into Incivek relapsed  Feb 2013 Had 72 weeks on interferon & Riba.

Rubye


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Looks good John!

It's those little mistakes that can totally screw up everything. It's good to see your doctor straightened it out for you. Take care.



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UNDETECTED 5/4/15 - 16 weeks after EOT, 1st treatment - Sovaldi and Olysio, Geno 1a, 67 year old with compensated cirrhosis, over 40 years with HCV.
shadow10cats


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Thanks for the info!

I hope he is able to get this OK for the time he needs.

I am just so freekin happy that I am on it and it's not screwing up my life every day!! Think About It!! We went from puking sick, hair falling out, burning rashes from hell to maybe a headache or some dehydration.  Such a HUGE difference!  It's just so amazing how we went from a 3 nasty drug regime to one pill a day.  

I am so thankful I got  on Harvoni, the process was quick and pain-free & I can actually have a nice quality of life while I'm on it! 

Because of this I will do anything I can to help others get the meds they need.  Just ask!

John:  So if I am reading this right, you called your Dr and he "said" it "should be" OK now?  Have you followed up? I would keep on top of this. A call or two doesn't take that much out of your day & you don't want to get on this then when month 4 rolls around you find there's an issue.



-- Edited by shadow10cats on Wednesday 28th of January 2015 07:27:16 PM

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Diagnosed 10/04 / VL 12.7 M / Genotype 1b - Grade 2, Stage 1 / 2007 -Pegylated Interferon & Ribavirin - Stopped Due to Sides / 2011 - Telaprevir, Interferon & Ribavirin - Stopped Due to Sides / APR 2015 - COMPLETED HARVONI So Far Undetectable :) 
Tig


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Hi BJ,

Yes, both Harvoni and Sovaldi are indicated under certain circumstances for 24 weeks. The Sovaldi (w/wo Riba) component itself is just about as expensive per treatment regimen, not quite, but Geno 3's and some Interferon ineligible patients are recommended for 24 weeks as well.  Harvoni, particularly treatment experienced with cirrhosis should treat for 24, but as you know, all decisions are between physician and insurance carrier.

http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf

http://www.hepatitisc.uw.edu/page/treatment/drugs/sofosbuvir-drug

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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JLynch30


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To:

John Lynch

From:

AMY CATHERINE MCCLUNE MD

Received:

1/28/2015  9:07 AM PST

I corrected them yesterday. You should be ok.

----- Message -----
From: LYNCH,JOHN
Sent: 1/27/2015 8:10 PM PST
To: AMY CATHERINE MCCLUNE MD
Subject: John Lynch Harvoni

Hello Dr. Mcclune,
I hope I am not going to have a problem with the pharmacy here.

they said they have me as 12 weeks only and will not refill my next prescription with an okay From the higher ups - will I be okay with this



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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

 
shadow10cats


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RE: Can Pharmacy overrule Prescription?
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That is a new one for me! I personally have never heard of anyone being on the drug for 6 months.  I didn't think that was even necessary for this medication.  Being it's so powerful, efficient and EXPENSIVE!!

Here is what I would do if I were you:

First, just based on the fact you can get Harvoni but only for 3 months tells me your Dr. did a Pre-Auth.  

#1 - CALL YOUR DR:
          -  ask if he did a Pre-Auth. & Was if for six months or 3?

           - The Pre-Auth was for 6 Months: 
            Yes He Did a Pre-Auth & Yes It Was Approved for 6 Mos:
                              Then there  is most likely some mis-communication going on.  First, get some verbal info off the Letter from your Ins Co. Approving the Pre-Auth - such as the DATE of the Approved Pre-Auth & WHO approved it & for HOW LONG you were approved to be on it .  Next, get a COPY of the Pre-Auth & the Approval from your Ins Company via fax, email, medical portal or snail mail.  For stuff like this it is always a good idea to have a copy for your records.  Now you have some info you need.  

            Yes He Did a Pre-Auth for 6 Mos But is was only Approved for 3:    
                             - If he applied for 6 months, let him know, that according to the pharmacy you only got approved for 3.  You need that letter from the insurance company to be sure of what he applied for & what they approved. There could still just be some mis-communication going on.

                            -  If he never applied for 6 months make sure you didn't misunderstand the period of time you need to be on it. If he definitely wants you on it for 6 months & that's what he applied for again, you need that letter.

                            - If you are only Approved for 3 Months & he wants you on 6 -you will need to Appeal.  
                                     (Not sure how this will affect your starting on Harvoni. Would you take the 3 months and get on it & in the meantime appeal for the additional 3 months?  When you appeal they have to respond in 30 days so you'll know before the 3 mos is up whether or not you will get the additional time.  Maybe Gilead will do the additional 3? You could call Gilead & tell them you need 6 but only got approved for 3 & if you appeal & get denied a 2nd time could you go to them for the last 3?  If they say yes then you "should" have nothing to worry about.  Start the drug, Appeal your case, If they say yes - you are good to go, if they say no then go to Gilead. Just don't waste any time bec you don't want to run out of drugs while waiting for Gilead to approve.  Then of course they don't supply the Ribavirin as far as I know so is it OK for you to take that for only 3 mos then just be on Harvoni? That's a whole other issue.)

In either case you need to know for sure: How long he wants you on it,  How long You were actually Approved For,  And again make sure you have copies of All Transactions!

  #2 - CALL YOUR INS COMPANY.  

           - If your Dr. did a Pre-Auth & it was Approved for the 6 months provide the info you got verbally from your Drs office. I am assuming at this point your ins company will key in whatever data required for you to rec it for the 6 months & you can go back to your pharmacy.

            -If he applied for 6 but you were only approved for 3 find out info about how to Appeal & have them get you the forms etc ASAP. Then go back & discuss with your Dr.  When speaking w/ your Ins Company about this always make note of who you spoke to, date, time & what was discussed.  It may come in handy later.

In any case, it sounds like you will need to appeal. Whether you or you Dr does this I don't know, I had to do my own with a supporting letter from my Dr. (he was little help). For most their Drs office did the appeal. I guess for  me the biggest decision would be whether or not to start the treatment while I wait for resolution.  

Best of Luck but I'm sure you will get it resolved with a few calls. 

 



__________________

Diagnosed 10/04 / VL 12.7 M / Genotype 1b - Grade 2, Stage 1 / 2007 -Pegylated Interferon & Ribavirin - Stopped Due to Sides / 2011 - Telaprevir, Interferon & Ribavirin - Stopped Due to Sides / APR 2015 - COMPLETED HARVONI So Far Undetectable :) 
Miss B


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Hi John,
The pharmacy is just following the rules of the insurance co. I seem to remember that you have Kaiser? If this is correct, then the pharmacy IS fully controlled by KP, so it's just following what it is told to do. When I had a similar problem, I sent my dr. a letter via the patient portal detailing the reasons why I needed 12 weeks not 8 weeks. I asked the dr. to submit my letter to the Regional HCV Committee for review. He did & I was approved for the 12 weeks. The patient portal only gives a small space for messages, so I attached a .pdf.
Just a hoop that needs to be jumped through.
Good luck!

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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!  
JLynch30


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I was prescribed 24 weeks Harvoni and Ribavirin from my doctor.  I went to get my prescription today and the pharmacy said it was only okayed for three months and they would have to get approval - can they go back on a prescription if guidelines changed since I have been on???



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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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