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Hep C Discussion Forum -> General Discussion -> Insurance denials
Post Info TOPIC: Insurance denials
Tig


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RE: Insurance denials
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Hey Rob,

Here's a link to the Gilead letter:

http://www.aidshealth.org/wp-content/uploads/2015/07/gilead-letter.pdf



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Tig

67yo 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!

Hep C FAQ   Lab Ref. Ranges  HCV Resistance

Signature Line Set Up/Abbreviations   Payment Assistance

 
Gracie


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Sometimes the momentum people can come through. They called me tonight as my pharmacy signed me up for their support path program to see if they will cover my co-pay. I guess my primary insurer has a $50,000 per year max which I've exceeded. My husbands plan is taking over, but they require a $3000 co-pay. The momentum people are covering it. And rightly so with the bucks they are making off me, but it's a relief none the less. Keep trying! It's bound to come through for one of the treatments with persistence!



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  1. Gracie

1A. Previously treated non responder Rebetron in 2000 And Incevik in 2014 with a breakthrough at week 12. Fibroscan 15.5. VL 6,000,000. Finished 24 weeks harvoni on Dec. 19, 2015. SVR. Latest Fibroscan 8.8.
Brian1412


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Somewhere on this forum is a copy of the letter Gilead issued in regards to the practice. Of insurance companies trying to game the path program. It may be informative and more relevent today. Also remember that obamacare was affirmed in the near past. Which is relevent. If you have a engaged dr. You can still get Harvoni via the path. You just have to have your dr demand it. Get your dr to push it thru.. and he can ...it is worth it to try. The. Can do it. And grt you on the. 5 dolar co pay. They are doing it lefy and tight in. South fl

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mweichel


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Thank you  for all the replies and support. I am trying to stay hopeful and positive. As bad as I feel physically now, I can't imagine feeling worse. But I am working with my doctor and the liver team. I have talked to them yesterday and i am to speak with them again next week. so maybe I will mention if I can't get approved for harvoni, maybe I can do another treatment. Thanks so much everyone!



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58y/o GT 1a VL 14 million no prior treatment stage II fibrosis Ast 44 Alt 43
Flower Child


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Hi, 

Insurance denials are no doubt frustrating. Please know you do not need to wait until you have stage 4 fibrosis in order to be treated.    Your doctor is going to advocate for you and will likely have back and forth exchange with your provider.

Because there are several treatment options with various prices all having optimal results, insurance may have a standard protocol for accepting specific medications - especially the more expensive treatments.  If your doctor needs you on Harvoni for specific reasons that rule out alternatives then the doctor will relay this to insurance in  a manner that leads to approval, if necessary.   Most likely, insurance will approve alternate treatments, and if your doctor feels these options will also suit your individual needs and best interest then it may be a new suggested Treatment plan.   

I anticipate this happens in many cases and have been reading up on it to prepare for a friend. 

Keep posted, best of luck and take good care.  



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~Rebecca

Support for: 52yo, Geno 3a, F1. Tx: Dak/Sov-12 wks SOT: Dec 2015. VL 1mill at SOT

VL~58 - taken 5 days after start; VL UND @ 2 wks; UND 1 mos; UND EOT
Penelope PePod


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Hi Mary,

My husband and I were denied twice for Harvoni.  So the doctor prescribed Viekira for us and it was approved.  The success rate is pretty much the same.  The only difference seems to be the number of pills you take a day, and we haven't felt it much of a hardship to have to swallow twice instead of once.   As long as it gets the job done! 

Try to relax and don't worry.  Most of us have been right where you're at.  Best of luck to you, and please let us know how it turns out.  The folks on this forum are priceless for their knowledge and support.  Welcome to our little group!

Penny

 



-- Edited by Penelope PePod on Friday 14th of August 2015 03:25:53 AM

__________________

65;  Dx 1997 1a; VL 1.1m; TX naïve; SOT 7/20/15; 12 wks viek/riba 1200mg

09/14/15 draw: Undetected 8 wks into tx

10/12/15 draw: Undetected at EOT

01/05/16 draw: Undetected at E0T+12
Femapples


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Hi there,

My insurance didn't cover Harvoni because Gilead wouldn't negotiate with Express Scripts.  They cover Viekira Pak, which is what I used.  The difference is that I had to have Ribaviron which is no picnic but still a cakewalk compared to my previous treatment of interferon and Ribaviron.  As you can see by my signature line, I'm undetected and was undetected at 4 weeks.  So, not to worry about which drug you'll use.  In my opinion, Harvoni and Viekira Pak are both fine.

F.



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Hep C, viral load 26,000,000, monoclonal gammopathy of undetermined significance (kidney), glomerulonephritis (kidney). 1994: Interferon, 2005: Interferon & ribavirin, 4/1/ 2015: Viekira Pak & Ribaviron, 12 weeks EOT: virus UND
dharmabum


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Hi there and welcome.  I was denied three times and was finally approved for Harvoni after testing showed that liver disease was progressing.  I also changed insurance companies after having a conversation with my doctor's assistant.  He told me who was approving treatment at that time (January 2014). 

Healthcare system can be frustrating and demeaning, but hang in there and work closely with your doctor and staff.  I was terribly fatigued and also had horrible gastric issues all through treatment.  I finished 12 weeks of Harvoni in April and I am slowly feeling a difference in mood, outlook, & general physical wellness.

Take care and keep your chin up.

 



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Joann

 

Geno 1a  - failed Tx Inc/Int/Rib - Tx Harvoni 1/14/15 - UND at EOT 4/7/15, 7/7/15, 9/9/15, 12/04/15, 10/26/16
Cinnamon Girl


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Hi Mary,

I know how disappointed you must be feeling but please don`t despair!  Unfortunately this is a common scenario with Harvoni as it`s such an expensive drug, and your doctor is correct about many people being denied on their initial application but then getting approval on appeal.  Gilead also has a Support Path which can help with payments in many cases.

With a fibrosis score of F2 you certainly don`t need to panic, and as Gracie said there are other treatment options and more coming along in the pipeline.  I do understand about the fatigue, it makes everything so much more difficult to cope with, but take it step at a time and you`ll find a way through this! 

Best of luck, I`m sure other people will want to add more on this subject.

 



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Jill 

(71 yo, lives in UK)

Was Gen 3a, 

24wks Peg Ifn/Riba, Sep 2010 - Mch 2011

UND @ Wk.4, UND @ EOT, 

SVR Nov 2011 --> Still UND @ EOT + 4 yrs.

 

 
Gracie


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Can they ask for Vik Pak? Think that one is easier to get And still well over 90% success rates.

And with F2 fibrosis, you can afford to wait for treatment. There are new ones coming which will force the prices down. You'll be SVR before you know it. I wouldn't worry about a transplant. Your far from that stage. 



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  1. Gracie

1A. Previously treated non responder Rebetron in 2000 And Incevik in 2014 with a breakthrough at week 12. Fibroscan 15.5. VL 6,000,000. Finished 24 weeks harvoni on Dec. 19, 2015. SVR. Latest Fibroscan 8.8.
mweichel


Newbie

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I received a letter from my insurance provider stating I don't meet their criteria for payment of harvoni. the criteria is stage 4 fibrosis with cirrhosis. At this point, I will need a transplant. Needless to say I am very angry and disappointed. My doctor told me on my visit with her that they handle all appeals and it is not unusual to be denied initially. I am waiting to hear from them as to where I stand. My doctor's nurse said it doesn't look good due to the criteria. I have stage 2 fibrosis with greater than 14 million viral load. I have terrible GI issues and fatigue. Has anyone else experienced this and what did you do to get insurance approval?

Thanks for any feedback.

Feeling down, hopeless and scared.



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58y/o GT 1a VL 14 million no prior treatment stage II fibrosis Ast 44 Alt 43
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