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Hep C Discussion Forum -> General Discussion -> Prescription Help
Post Info TOPIC: Prescription Help
angela72


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RE: Prescription Help
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Hi Tig56

Thank you so much for your helpful information! I am going to pass this along to my doctor and Ill also call myself. I am her only patient with GT3, so I think that is why she is fighting so hard for me, she is also getting frustrated as well as her PA, as she does most of the talking to the companies. Ty are both great. Ill be on here now since I found this forum, you all have so much useful information on here. I just got diagnosed in June and this is so new to me and I enjoy learning new things about this and I also love to here the success stories. It helps me to know that I can get through this. I wont let it beat me. Anyways, thanks again for the information and I look forward to hearing from you more.  Thank you again.

Angela



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Genotype 3

Prescribed Sovaldi and Daklinza
Tig


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Hi Angela,

I'm sorry you're having such a difficult time getting the approval for your treatment. I can't understand what the heck your insurance company is thinking! Daklinza can't be prescribed for Genotype 3 without Sovaldi. To approve one without the other serves no purpose whatsoever. I would ask your doctor to inquire with the authorizing individual or board and ask them who the world made such a decision. They obviously don't understand what's required in your situation. There is ongoing research on the use of different combinations, but any protocol that utilizes Daklinza for GT3, must include Sovaldi (Sofosbuvir) with or without Ribavirin. It's extremely effective as well. The other research includes Harvoni with Ribavirin, Sovaldi and GS 5816 (Velpatasvir) from Gilead. But if Daklinza is prescribed for GT3, it must be combined with Sovaldi. Your doctor may decide to wait on an upcoming treatment option and they're discussed briefly at the end of the article provided below.

Core Concepts. Treatment of HCV Genotype 3

You may also give BMS a call and seek advice from their patient support representatives. They often will contact the various individuals responsible for making some of the decisions in your care. Perhaps they can knock some sense into your insurance provider that has made this decision. The contact information is included below.

"Bristol-Myers Squibb is committed to helping patients through treatment with Daklinza. For patient support and financial assistance, patients and physicians may call (844) 44-CONNECT (844-442-6663). This number offers one-stop access to a range of support services for patients and healthcare professionals alike, including benefits investigation by care counselors, comprehensive coverage research and emergency shipment for access-related issues."

FDA Approves Daklinza

These are just ideas and I hope that you are able to work with some of the recommendations provided here. We're all on your side and will do our best to assist you any way we can. Just don't quit trying! Use your appeal process and if you lose one appeal, file it again! We see these appeals approved all the time, so keep on them. Your doctor sounds like she is more than willing to fight for you, that's very important and you're fortunate to have such a caring physician. They have doors that only they can open, so let her know your willingness to help her any way you can. Trust me, the doctors are just as frustrated and angry about the way HCV treatment is being handled by these dis-interested, bean counters in the insurance industry. It doesn't help that Big Pharm in the US and abroad are more interested in profits than they should be. This is a sore subject around here. We have many stories of similar incidents like yours and they aren't limited to one protocol, but all of the new DAA's. Keep up the fight and if we can help, let us know. We're all in this together! Good luck...  smile

 



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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!

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JimmyK


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Express Scripts uses Acredo as their "Specialty Pharmacy". I know as I have them. It is possible you are right and the Contract may include volume incentives. However they are supposed to follow the proper protocols and it is in their best interest to do so. If your treatment is not successful they would still be on the hook for the cost of post failure treatment.

Is this a group plan through your work? If so and the Company is big enough I would head straight for Human Resurces and file a complaint and also get them behind you and the Doctor.

 

 



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
angela72


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It is about the same, $90K for the 12 week recommended dosage. Express Scripts which is my prescription coverage, has a contract with the makers of Veikira Pak and keep pushing it and they are not even taking into consideration that it is only for Genotype 1. I just don't understand them. My doctor will fight for me she has wrote about 20 letters so far, I just hope she don't give up on me.

__________________

Genotype 3

Prescribed Sovaldi and Daklinza
JimmyK


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Also please see...

 

http://hepcfriends.activeboard.com/t56904226/payment-assistance-programs/



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
JimmyK


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Others with more information than me will chime in i am sure. I really don't get it. Viekira runs a little better than $28k per 28 day supply.

What does the Sovaldi run?

 

 



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
angela72


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My doctor is great, she has gone through 3 appeals with the insurance company and 2 with Gilead which makes sovaldi. she is great but we are running out of options

__________________

Genotype 3

Prescribed Sovaldi and Daklinza
JimmyK


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Do they have an appeals process and will your Dr go to bat for you. Mine had to and he was successful.



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
angela72


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I have private insurance but they will not approve Sovaldi. They did approve Daklinza. I cant take one without the other. My insurance recommends Veikira Pak but that is for Genotype 1

__________________

Genotype 3

Prescribed Sovaldi and Daklinza
JimmyK


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Posts: 1839
Date:
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Insurance?



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
angela72


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Posts: 6
Date:
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My doctor prescribed Sovaldi and Daklinza
But I haven't started any because I cant afford the out of pocket costs for Sovaldi

__________________

Genotype 3

Prescribed Sovaldi and Daklinza
JimmyK


Guru

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Posts: 1839
Date:
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Welcome

 

What did your Doctor prescribe?

 

JimmyK



__________________

Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

"I go to war with the brothers I trust."
angela72


Member

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Posts: 6
Date:
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Hello! Anyone know how to get Sovaldi approved by your insurance company?  I have Genotype 3 and need Daklinza, which was approved by my insurance,  they will not approve Sovaldi.  I have tried through Gilead but they wont help because my insurance company recommended Veikira Pak, which is not for Genotype 3. If anyone knows anything to help I would greatly appreciate it. Thank you



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Genotype 3

Prescribed Sovaldi and Daklinza
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