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Hep C Discussion Forum -> New Members Area -> Have Epclusa Script -not accepted by Insurance
Post Info TOPIC: Have Epclusa Script -not accepted by Insurance
Canuck


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RE: Have Epclusa Script -not accepted by Insurance
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RC,

Funny, I said pretty much the same thing (way back when), when I was waiting, waiting, waiting, desperately seeking/hoping/wondering which sof/vel trial I might/could get into - back then, I was just drooling/pining watching "tkflex36"  belly up for his meal at the sof/vel trial bar, and I said "I'll have what he's having please"!

I know I am jumping ahead, but have you settled this decision with your team - what drugs THEY will want to use for your HCV? I know what YOU want, surely THEY know what you want. Did they agree, when the time comes?

It will be interesting to see what happens with VOX, HOW popular it will become, it SHOULD!, compared to riba (considering ALL the attributes between the 2), but, so far it looks like only riba is going to be used with Epclusa (when required) for now.  VOX, as I read it, is superior in important ways. Why don't we hear more talk or rumours about VOX yet?? C.

 



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
robertsamx


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Thanks C, and I would like a side of VOX with that EPCLUSA.  RC



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 M-64) 3 Treatments)( SOF-RIBA 2014)(SOF-RIBA-PEG 2016)(HCC 2016) (LIVER TRANSPLANT 8-2017)(VOSEVI-RIBA 2017)   SVR-12. 3-13-18   
Linuxter


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Canuck wrote:

Linux, These trials wouldn't help MommaT anyway, as she does not live in Malaysia, Singapore, Russian, Sweden, nor has she had a liver transplant in Switzerland! Geez, why does there ALWAYS have to be something in the way! C.

 DOH ... 

 

L

(Thanks for 'splainin')



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63yy,HCV,2b,F3-A1, Sof/Riba,12wks Tx   SOT: 1/20/16, HCV-RNA 9,816,581, ALT 56, Hb 14.6

4wk: HCV-RNA <15 Detected, ALT 15, AST 17, Hb 13.6 EOT: 4/12/16, ALT 18 , Hb 12.9176a2f85d05d9c965eafe199f2ba9ba5.jpg SVR Achieved 7/8/16

 
Canuck


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RC,

Will be interesting to see how Vox progresses.

YOU will be a lucky guy, as you will now not have to wait/search for "trial" Epclusa, YOURS is going to be served and delivered to you on an "approved" platter! You have the best maitre d's at your table.

C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
robertsamx


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I think we have seen the end of the Gilead trials for  Sof-vel-vox and any combo of the mentioned drugs, Gilead has moved on to hep-b drugs in R/D.   RC



__________________

 M-64) 3 Treatments)( SOF-RIBA 2014)(SOF-RIBA-PEG 2016)(HCC 2016) (LIVER TRANSPLANT 8-2017)(VOSEVI-RIBA 2017)   SVR-12. 3-13-18   
Canuck


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Linux, These trials wouldn't help MommaT anyway, as she does not live in Malaysia, Singapore, Russian, Sweden, nor has she had a liver transplant in Switzerland! Geez, why does there ALWAYS have to be something in the way! C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
Linuxter


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Hi Canuck,

Thanks for the excellent data ... once again you bring us such helpful, up-to-date and relevant information ...

... it's greatly appreciated!

MommaT,

As has already been mentioned, this all takes time, just work (communicate) with your doctor to get the insurance thing resolved. It sounds like your doctor will help push this treatment ... just takes a while.

Wishing you the best, please do keep us informed on how it's going.

 

Linux



__________________

63yy,HCV,2b,F3-A1, Sof/Riba,12wks Tx   SOT: 1/20/16, HCV-RNA 9,816,581, ALT 56, Hb 14.6

4wk: HCV-RNA <15 Detected, ALT 15, AST 17, Hb 13.6 EOT: 4/12/16, ALT 18 , Hb 12.9176a2f85d05d9c965eafe199f2ba9ba5.jpg SVR Achieved 7/8/16

 
Canuck


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MommaT,

I don't know how much prior searching you have done, re: trials, but you did ask (originally). Have you any experience searching NCT's - if not, it does take some practise and lots of reading to slog through the data. 

Here are the only 6 on "Epclusa" one I could pull up, after a careful read you, will see whether any are really running (for intake), where, and what their their exclusionary criteria are.

Whenever I have searched, there are always many that do not or will not pan out for one reason or another.

You have a script, your doc should be your best ally in helping you get the drugs (mainstream, versus trial), but, any which way would be good!

Was that the only" reason" offered to you and your doc from insurance ... that Epclusa will "always" be "too new" for them? - they have no other criteria for which they did (or would) base their refusal on?? C.

 

ClinicalTrials.gov
A service of the U.S. National Institutes of Health

Example: "Heart attack" AND "Los Angeles"

Search for studies: 
 
6 studies found for:    epclusa

Modify this search | How to Use Search Results

 
 
Include only open studies Exclude studies with Unknown status
RankStatusStudy
1RecruitingSofosbuvir/Velpatasvir Fixed-Dose Combination and Ribavirin for 12 or 24 Weeks in Participants With Chronic Genotype 1 or 2 Hepatitis C Virus Infection Who Have Previously Failed a Direct-Acting Antiviral-Containing Regimen
Condition:Hepatitis C Virus Infection
Interventions:Drug: SOF/VEL;   Drug: RBV
2RecruitingSofosbuvir/Velpatasvir Fixed Dose Combination in Participants With Chronic Hepatitis C Virus Infection Who Have Received a Liver Transplant
Condition:Hepatitis C Virus Infection
Intervention:Drug: SOF/VEL
3RecruitingSofosbuvir/Velpatasvir Fixed Dose Combination for 12 Weeks in Participants With Chronic Hepatitis C Virus Infection
Condition:Hepatitis C Virus Infection
Intervention:Drug: SOF/VEL
4RecruitingEfficacy and Safety of Sofosbuvir/Velpatasvir Fixed Dose Combination for 12 Weeks in Participants With Chronic HCV
Condition:Hepatitis C Virus Infection
Intervention:Drug: SOF/VEL
5CompletedEfficacy and Safety of Sofosbuvir/Velpatasvir Fixed Dose Combination for 12 Weeks in Adults With Chronic Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV)-1 Coinfection
Condition:Hepatitis C Virus Infection
Intervention:Drug: SOF/VEL
6Active, not recruitingEfficacy And Safety Of Sofosbuvir/Velpatasvir Fixed Dose Combination With Ribavirin in Chronic HCV Infected Adults Who Participated in a Prior Gilead Sponsored HCV Treatment Study
Condition:Hepatitis C Virus Infection
Interventions:Drug: SOF/VEL;   Drug: RBV

 



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
RAGDOLL


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Terry,  sorry for all your stress on this, but be patient.... This too will pass and I am sure the doctor can clarify that with your genotype etc.  EPCLUSA is the proper treatment.  Insurance companys sometimes slow on getting up to date.  Hang in there.  Chris



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F 63,  1b  1974, no cirrhosis, fibro scan 5.8 F0-F1,fibro test .37 ,V/L 702987, ALT 90, AST 75.  ABBVIE Topaz II on 10-30-14 Viekira Pak no RIBA , EOT 1-22-15 SVR, ALT 37, AST 29, 4-15-15 SVR12 - fibro test .22,  1-21-16 SVR 52 ,  1-21-17 SVR 104! 1-21-18 SVR 3 years ,2020 5 years, 2022 7 years!
MommaT


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Hi! Thank you for your reply! You give me direction of what to do and 

hope that the cost can be negotiated. Thank you I needed that!!! Now 

to get my Dr to fight for the script.... she herself wanted - Epclusa!

I have waited for a medication I could feel comfortable with so this is BIG

for me! Tess 

 

 

 

 



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Tig


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If this is your first go at treatment, it is very common for your insurance provider to deny the initial treatment request. Your doctor has to appeal it and if necessary, request a peer to peer consult with the individual making the decision. The diagnosis of cirrhosis places you on the top of the list for treatment. There are a lot of stall tactics played, but a fact based rebuttal from your/his doctor should result in approval. 

I spoke to my daughter today, she works for a pharmacy in NC. She checked for me and said Epclusa is available through their supplier. The retail price for a 28 day supply is $24,359.30. So, it can be purchased and certainly is available.

Harvoni is used for genotypes 1, 4,5 and 6.



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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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MommaT


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Hi-I think I was in denial about the HE c for years because my ALT/AST were low AND the drugs being used to treat were HARSH. I took notice when I heard about Sovaldi had no Interferon BUT still there was still the RIBAVIRIN-Fast forward to My ALT/AST high and now Compensated Cirrhosis-2016 I was so EXCITED about NEW Epclusa-No interferon/ribavirin and now I am BLOCKED! I want a Med I can get behind and be successful with. Thank you for listening! Tess



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MommaT


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Hi Candace-I think Harvoni is for Genotype 1. Interesting to hear that Epclusa being accepted instead of Harvoni for Medicare patients. You are right the Epclusa is $75,000.00 and is cheaper than Sovaldi/Ribavirin $84,000. So why would Amerihealth deny and not see the savings and that it is better tolerated? I am angry! The CDC website recommendation for Genotype 2 says to use Epclusa. They now know that the Ribavirin is more toxic and less tolerated and should be avoided if possible. So to get Insurance companies on board when the FDA fast tracked this medication is a challenge to say the least. Thank you-I am venting



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CandaceV


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You probably do remember my posts...my husband was in denial for 25 years and refused to get tested.  It took another 5 years to get him to agree to treatment.  Why he felt like that escapes me.  Why anyone would prefer ignorant bliss to getting cured is just stupid.  Maybe fear.  I'm just happy it all worked out, and we have hope for a cure.
Canuck wrote:

Hey, good!

I was hoping you two would meet/chat/compare notes.

It's always good to do so.

You just never know just what info might come up that proves useful!.

Candace - I replied to you hurriedly a bit ago, but I do believe (now) that I recall prior posts from you, re: your hubby, so it is a welcome "back" to you then! Glad you got the Epclusa! C.

 



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Tig


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Here is some additional information on the recent release and availability of Epclusa. Please note that Gilead's Support Path Patient Assistance program is available for those qualified. 

Gilead Sciences - Epclusa

There are a number of patient/payment assistance programs available. There's a blue link in my signature line that will take you to a thread here with a list of organizations that may be able to provide help.



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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

 
CandaceV


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Medicare paid because it was cheaper than Harvoni...Harvoni was $103,000 vs. $75,000 for Epclusa.  The foundation that helped was Patient Access Network (PAN) 1-866-316-7263.  Good luck, let me know if you need anything else.
MommaT wrote:

Hi! Thank you for your reply. I have Amerihealth and they denied the Epclusa saying it may never be covered with them because it is new.. What foundation helped you? I am in New Jersey and My husband and I make under $100,00.00. I really think a no Interferon or Ribavirin medication is superior! Thank You!

 



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Canuck


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Hey, good!

I was hoping you two would meet/chat/compare notes.

It's always good to do so.

You just never know just what info might come up that proves useful!.

Candace - I replied to you hurriedly a bit ago, but I do believe (now) that I recall prior posts from you, re: your hubby, so it is a welcome "back" to you then! Glad you got the Epclusa! C.



__________________

HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 64 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)
MommaT


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Hi! Thank you for your reply. I have Amerihealth and they denied the Epclusa saying it may never be covered with them because it is new.. What foundation helped you? I am in New Jersey and My husband and I make under $100,00.00. I really think a no Interferon or Ribavirin medication is superior! Thank You!



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CandaceV


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Hi MommaT, my husband got Epclusa, started today. He's on Medicare and has a supplemental policy. A foundation here in Ohio paid his $585 co-pay as well. He has a gastroenterologist that handled insurance. Where are you located? He's using a specialty pharmacy who can help you get it if you're in the States, and their number is 1-844-428-7387. It's Aureus Specialty Pharmacy. They can get a referral from your doctor and work with insurance and grants. Income for 2 people less than $100,000 annually can get help with co-pays. Let me know if I can be of any further help.

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MommaT


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Hi-I am Hep c 2b -found out after 9/11/2001 when I donated blood. My ALT and AST are high I just got Fibroscan

Compensated cirrhosis.

I do not understand if Epclusa is highly tolerated without side effects and all genotypes -why it is not available.

Also see that there are people taking it maybe trials? Any input I am exhausted calling and researching getting nowhere!



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