Hep C Discussion Forum

Canuck · Guru

RE: Harvoni denied by BCBS

Tig · Admin

Congratulations Cheech! You'll be shouting success from the rooftop in no time. The importantance of a good diet, plenty of rest, hydration and compliance cannot be over-stressed! The time will go by quickly, even though you may feel differently on occasion! So commit to it totally and you'll be celebrating in no time! Good luck smile

Phoenix17 · Senior Member

Yay Cheech! Glad to hear that you are on your way to SVR! I drink coffee in the morning then pretty much water for the rest of the day. I try to drink a gallon of water a day. It helps with any side effects that you may have and it keeps things moving along. You will do well!

JimmyK · Guru

Cheech this is the outcome I was expecting.

Been there done that and I am a "hard case" so this will be a breeze for you.

1) Set a time. I am the 5:55am guy so other than that all other times are available. Pick one and stick to it x 84. This is a larger part of compliance and compliance is the largest part of success.

2) Water

3-7) More water

8) EXPECT success.

9) Remember to thank someone.

10) Welcome to SVR

JimmyK

wendyo · Guru

That's terrific Cheech!

I continued to have coffee/tea in the morn. And plenty of water all day long. And then some. As far as food, try to eat healthy. Cut down on processed food, sugar. Listen to your body. I would put fruit in my water to give it some flavor as well as drink decaf ginger tea to try to have a bit of variety. Lots of folks got into smoothies as well. You will see as they all reply

wendy

Cheech · Member

Hey folks,

Just received a call today. Looks like the dispute that the doctor put into BCBS was worthwhile. Harvoni has been approved for 12 weeks. Hooray! Any tips on diet while I take this? I do drink coffee and tea in the morning and maybe a half gallon of water throughout the day. smile

Thanks to all who have chimed in!

Best Regards

Cheech

Canuck · Guru

Tig is invaluable. Thank goodness he has knowledge, experience and memory. I always have to "guess", or, try to look it up, and/or re-learn it all over, again and again!, if I ever do learn it in the first place!!

I find the testing stuff hard. I vote we keep making Tig store it all in his memory banks and just make withdraws as required. Waaay easy for us! Good on Tig.

I get completely lost in it, what with ALL of these!!!:

FibroMeter, FibroTest/ActiTest/FibroMax, ELF, HepaScore, FibroSpect, Shasta, APRI, FORNS, FIB-4 and all the labs and parameters they use, or exclude to get you "measured"!!

BRO-THER! smile C.

Canuck · Guru

True Cheech,

Yes, there IS always viekira to fall back on. But, leave no OTHER stone unturned. Epclusa, or perhaps some other regime your doc might be able to opt to, may be more "user-friendly" than doing viekira with riba. smile C.

Cheech · Member

Thank folks,

If BCBS keeps denying Harvoni I do have the approval for the V=Pak. I guess things could be worse. Heck, years ago there really was no easy treatment.

Best to all.................

Tig · Admin

Want to add a link to this fibrosis blood test. I imagine this is how Cheech's was determined. They are using blood marker ratios and algorithms with more regularity. Not a real fan of that, but they are more accurate at the low and high ends of the scale, my opin anyway.

FibroTest

Tig · Admin

Hey Cheech,

You may get some help by reviewing our page of abbreviations. There's also some info on setting up your sig line if needed. Be sure and review the Knowledge and Info sections here too.

Sig/Abbreviations

Canuck · Guru

Hey Cheech,

Don't stress unduly over terminology or finding out stuff, trying to know everything all at once - you and your doc are already doing the most important parts.

It is stressful enough just going through the good things you and your doc are trying to do - to get you to treatment drugs.

Just concentrate on that, and know it will happen sooner or later, hopefully sooner, just for your sake.

If it continues to be delayed, be assured that it will happen, your doc will watch you, you are on his good radar now.

If they keep declining the Harvoni, then your doc will have an idea what he wants to do next, he may try another appeal for Harvoni, or if they keep declining Harvoni, then he no doubt would have other drugs in mind for you that would work well. If you keep getting declined, have that discussion with your doc, ask him what are his choices of ideal drugs for you (in a perfect world) and in what order. Epclusa may well be on his list of choice drugs. Worth knowing/discussing his opinion on second/third/fourth best choices for you.

Good you had the abdominal ultrasound. Renal cysts and lots of other minor oddities can be found, believe them if they say the things they see are of no significance/consequence.

I do not think you have had a "FibroScan" done at all. So, I don't know what (which) test(s) you've had that gave you that "fibrosis" level of .11. They could have deduced your "likely" level of fibrosis by other means (there are many ways) - some by complicated calculations of assorted blood test and other factors.

If you get an opportunity to speak with this nurse again, you could ask her to tell you what your ALT, AST and bilirubin are, just out of curiosity to see if they are elevated, or how elevated they are.

You could ask her what "Fscore" they have put you at ... i.e. F0, F1, F2, F3, or F4, and what test (the name of the test) they used to determine this.

You can aslo search in this site for info about FibroScans and Fscores if you are interested. We are assuming your Fscore is low.

Are you finding this a stressful time? If so, try not to be stressed, we are here for you, and your doc is pulling for you, and you will get there. Concentrate on the plodding forward motion. smile C.

Cheech · Member

Hey folks,

As I did down in the string of notes I have to thank everyone for their views. Good to see that most agree that Harvoni and the short period is the way to go!

Best to all!

Cheech · Member

Hey Canuck,

Thanks for the great info. Most still sounds Greek to me. confuse I had the ultra sound and strange enough it showed a cyst on my kidney. I was told that it is fairly common and nothing to worry bout. The only other test was a bunch of blood was drawn and that is the numbers the nurse communicated to me. Should I ask for a FibroScan number?

As I stated before, it appears that BCBS is trying to save a few schekles by providing the 12 week V-Pak versus the 12 weeks of Harvoni that the doctor requested. He said that he put the longer period in there to be safe but in his experience 99% of the people with my numbers were cured in 8 weeks. He stated they may deny it.

Again I feel fortunate that I have had no noticeable issues and hope that everyone that is in our boat gets better.

Best Regards,

Cheech

JimmyK · Guru

Tig56 wrote:
Hey JK,
What did I do now? I wasn't aware of his genotype or tests when I surmised!

Greetings Grandpa.
What did you do? Nothing. It was a test.... you passed. LOL

Tig · Admin

Hey JK,

What did I do now? I wasn't aware of his genotype or tests when I surmised! smile I guess I wasn't clear about that. Sorry for the confusion. Now we know it's a 1A and you're correct, geno 1A requires Ribavirin and 1B w/cirrhosis. (I love you too!) wink

I would prefer the Harvoni treatment, even wait for Epclusa. They're both excellent courses of treatment. Avoid the Riba if possible.

JimmyK wrote:
Greetings.

I greatly love my brother Tig but in this case I do not agree. The V-Pack in treating a 1A will include Ribavirin and will be a minimum 12 week course.

Your numbers call for 8 weeks of Harvoni and it is in fact the preferred treatment option with BCBS over V-Pack due to contractual breaks.

Pursue the appeal and you will win and be on a much better protocol.

JimmyK

Canuck · Guru

Hey Cheech,

Nice to hear from you again, thanks for getting back to us, atho i wish it had been with good news about your approval.

Harvoni approval may happen yet, hang in there. It may be just a matter of time. Sorry for the uncertainty tho.

I like the sound of your doc going to bat for you like that, with "reasons" for Harvoni over viekira, it may pan out yet.

Good to know you are a GT1a. As a 1a you are a candidate for Harvoni, if that appeal fails, see what else you and your doc can argue to win his "wanted" choice of drugs. Find out from your doc if Epclusa is another choice for you, in many states it seems that many are getting Harvoni, easily, other states are now also starting to get Epclusa more easily.

In the meanwhile, it does look like time is on your side, and that time has been kind to you are far as damage - as indicated by with what appears to be a low Fscore and what your doc is telling you, even tho you have had the virus for a fairly long time. I am not understanding which test(s) they actually used tho, to arrive at this current figure of 0.11. You said ... "liver biopsy 3 years ago and it turned up very minimal scarring. Just had an ultrasound 3 weeks ago ...". You did not have a " FibroScan"? An Fscore (from a FibroScan) is expressed in a kPa (kilopascal) number, and converts to give you an Fscore of F0, F1, F2, F3, or F4. An abdominal ultrasound tells them a lot, but generally does not give you your Fscore.

So, that would be helpful to know, what test(s) they used to arrive at this figure of 0.11. You say most of your lab tests are not too bad, and I trust your doc is correct assessing you as having minimal damage, but do you know any of your other labs, such as ALT, AST, bilirubin, etc.?

Let us know if you find out anything more about your labs and assessments.

I'm sorry they are keeping you waiting to find out what "kind" of drugs your plan wants to dole out in your state, and what your other choices might be.

Hang in there. C.

Shadowfax · Guru

Your numbers seem that you are a great candidate for complete recovery.

Keep going and don't give up until you get what you need. Harvoni is an easy TX.

Keep us posted.

SF

JimmyK · Guru

Greetings.

I greatly love my brother Tig but in this case I do not agree. The V-Pack in treating a 1A will include Ribavirin and will be a minimum 12 week course.

Your numbers call for 8 weeks of Harvoni and it is in fact the preferred treatment option with BCBS over V-Pack due to contractual breaks.

Pursue the appeal and you will win and be on a much better protocol.

JimmyK

Cheech · Member

Hey folks,

Just talked to the doctor and got the numbers you were asking about. I apologize as I am medical term ignorant. My viral load is 4860000. My Genotype is 1A. My Fibrosis number is 0.11 and I have no way to benchmark these numbers but as I stated before the doctor feels that I am a good candidate for a complete recovery.

Again, any feedback is appreciated. The pharmacy has not heard back from Blue Cross Blue Shield on the appeal. They sated that since I do take medication for insomnia Viekira is not recommended.

Thanks again,
Cheech

Cheech · Member

Hey, I just want to say thanks to all who have chimed in. Yeah, I guess I am damn lucky that I have had no real damage to date.

Best regards to all,

Cheech

Observer · Guru

I did the Canadian version of the Vpak for 12 weeks a year ago, I had side effects but I'm pretty sure they were mostly from the ribiviron.

I had HCV for 32 years and am chirrotic, have arthritis, autoimmune problems and allergies from the nasty dragon.

I just passed a year of being HCV free and I really do feel better, (more energy). I still have cirrhosis, but my arthritis and autoimmune and allergies are being easier to manage with a functioning/repairing liver.

My Dr. put me on Vpak because of my cirrhosis, he wanted me on for 12 weeks and in B.C. they would only pay for 8 weeks of harvoni.

blessings

Alison

Canuck · Guru

Cheech,

Obviously, you said you and your doc discussed Harvoni and Viekira

But, whether you are a GT1 (with no sub-type), or if you are indeed a known 1a or a 1b, there are subtle differences in which drug regimes are up for consideration for you, and reasons why. As well, of importance, is knowing as exactingly as is possible if you are indeed cirrhotic, or not. We are just assuming you are not cirrhotic. Thus you were getting our questions re: your sub-type and Fscore/fibroscans, etc. I show you these drug regime choices (near current), which also list Zepatier (grazo/elba) and Epclusa (SOF/VEL) - should the choices still be up for debate and deciding on. As Phoenix points out, you may yet get your Harvoni, as they have already started to appeal. It is always worth discussing fully with your doctor ALL the treatment regimes that may be available to you, if you can get a good, better or best choice. smile C.

New directing-acting interferon-free regimens are now the standard of care for the treatment of chronic hepatitis C genotype 1 infection.
For initial therapy of treatment-naive genotype 1a patients without cirrhosis, six 12-week regimens with similar efficacy are recommended in the AASLD/IDSA guidance (a) elbasvir-grazoprevir; (b) ledipasvir-sofosbuvir, (c) ombitasvir-paritaprevir-ritonavir and dasabuvir plus ribavirin; (d) simeprevir plus sofosbuvir; (e) sofosbuvir-velpatasvir; and (e) daclatasvir plus sofosbuvir. All regimens except the daclatasvir plus sofosbuvir have a rating of Class 1, Level A.
For initial therapy of treatment-naive genotype 1a patients with compensated cirrhosis, three 12-week regimens with similar efficacy are recommended: (a) elbasvir-grazoprevir, (b) ledipasvir-sofosbuvir, and (c) sofosbuvir-velpatasvir.
When treating genotype 1a patients with elbasvir-grazoprevir, baseline NS5A resistance testing is required to identify the RAVs at amino acid positions M28, Q30, L31, and Y93. If one or more of these RAVs is identified, then ribavirin should be added to elbasvir-grazoprevir and the treatment course extended from 12 to 16 weeks.
For initial therapy of treatment-naive genotype 1b patients without cirrhosis, the same 12-week regimens are used as for genotype 1a without cirrhosis, but with the following exceptions: (a) baseline resistance testing is not required for genotype 1b patients treated with elbasvir-grazoprevir, since treatment of HCV genotype 1b with elbasvir-grazoprevir is not significantly impacted by baseline NS5A RAVs and (b) for treatment of genotype 1b, ribavirin is not added to the regimen ombitasvir-paritaprevir-ritonavir and dasabuvir.
For retreatment of patients with genotype 1a who previously failed therapy with peginterferon and ribavirin, the same 12-week regimens are used as for initial treatment in genotype 1a patients without cirrhosis. For retreatment of genotype 1a patients with compensated cirrhosis, the recommended regimens are also the same as with initial treatment and compensated cirrhosis.
For retreatment of patients with genotype 1b who previously failed therapy with peginterferon and ribavirin, the same 12-week regimens are used as for initial treatment in gentoype 1b patients without cirrhosis. For retreatment of genotype 1b patients with compensated cirrhosis, the recommended regimens are: (a) elbasvir-grazoprevir, (b) ledipasvir-sofosbuvir plus ribavirin for 12 weeks, (c) ombitasvir-paritaprevir-ritonavir and dasabuvir for 12 weeks, and (d) sofsobuvir-velpatasvir for 12 weeeks.
In patients with genotype 1a or 1b infection who previously failed sofosbuvir plus ribavirin, with or without peginterferon, the recommended regimen is ledipasvir-sofosbuvir plus ribavirin; the duration of therapy is 12 weeks without cirrhosis and 24 weeks with compensated cirrhosis.
Multiple effective options are also availble for treatment-experienced patients who previously failed a regimen that included an NS3A protease inhibitor or a NS5A inhibitor.
For treatment-naive and treatment-experienced patients with genotype 1 infection, the new benchmark for sustained virologic response rates is 90% or greater.
The major barrier to treatment with all new therapies is the extremely high cost of a treatment course.

Phoenix17 · Senior Member

Welcome Cheech! Wow, The fact that you haven't had any problems in the last 30 years is great. I have has hep c for 37 years and have had quite a few problems from it. They are slowly disappearing after 7 weeks of Epclusa. I don't know much about the v pack,but I am sure you will get rid of this once and for all. They may approve the Harvoni yet. I didn't know about specialty pharmacy's before this either. The meds will be delivered to your home. I am finding them very helpful.

Tig · Admin

They probably have a sweetheart deal for V Pak! It's hard to say, but I would like to see them consider the patient's point of view. Thankfully the treatments are far easier than they were back when I treated. I just missed Sovaldi's implementation and then came V Pak. If you don't need Ribavirin and from the way you described things, you shouldn't need it. Without more info, I'm just surmising... smile

You're very fortunate to have avoided problems after 30 years. Whew, is all I can say! 30+ years seems for many to be when things started worsening. Most of us didn't know and there wasn't the attention being given to treatment then. The rates of SVR were abysmal. You can be confident that you'll get this resolved quickly. You may experience some side effects, but they should be minimal and most often are minimized with an adequate hydration program. We recommend 3-4 liters of water everyday. That's vital!

Here's some Abbvie info, which includes a copay coupon. Check it out.

Viekira Pak Coupon

Cheech · Member

Hey Tig and Canuck,

Thanks for the response. My health is pretty good. Just turned 59 and have had no issues. As a matter of fact for the last 30 years after I found out I had Hep C I did not really think about it. I figured I would go to the doctor now since their are effective treatments available and before the crazy politics in our country completely destroys the healthcare system. I have had all the blood work done and every year they check the activity and it was for the most part dormant if that is the right term. I had a liver biopsy 3 years ago and it turned up very minimal scarring. Just had an ultrasound 3 weeks ago to look at things and the doc said everything looks good. I would have to call the doctors office for the specific numbers but in short, he said I have had no real damage from this virus. All number were low on the scale so for that I am very fortunate. The doc went with Harvoni as he has had great luck with it with nearly a 100% success rate. Only one patient that had to stop the treatment as they had some adverse reaction. The money aspect of it is what I am thinking. The pharmacy that is working on this is a "specialty pharmacy". Never knew they had those. In my mind BCBS is being short sided. With a cost of $65K for a Harvoni treatment for 8 weeks which my doc says in my likelihood would nip it in the bud or 12 weeks for for Viekira at $85K. I know the doc and pharmacy made a request for 12 weeks for Harvoni to play it safe knowing full well that the insurance company would most likely fight it. The cost for 12 weeks of Harvoni is $95K so BCBS is trying to save $10K?

At least I am staying positive. I'm just happy that there is now a treatment and I have not had any ill effects for this virus. Maybe it was all the hot peppers I like to consume? LOL. biggrin

Thanks,

Cheech

Tig · Admin

Hey Cheech,

Welcome to the forum. Don't be discouraged with the news that you'll be on the Viekira Pak treatment. It's very effective and you'll do well. Before I get carried away with numbers and figures, it would help a lot if you could give us a little more information regarding your health. Things like confirming your genotype, sub type, viral load, if you've ever treated before, fibrosis stage (have you had a Fibroscan, biopsy or other testing to determine it) and any blood work, like a liver panel which indicates your ALT and AST are all very helpful. That helps us to provide a better informed opinion.

Sometimes one treatment, based on the information I requested is better than another. Of course as you mentioned, it could be all about the money. Some practices are encouraged by some pharmacy reps to use one over another too. Again, money.... Keep in mind it wasn't too long ago that insurance companies were really making it difficult to treat if you weren't in an advanced stage of fibrosis. That has relaxed a little. You should also discuss it with your doctor and find out if s/he knows why the order was changed or denied in favor of the other protocol. An appeal can be done to see if they will change their mind. Now that it's after the first of November, the fiscal coffers are renewed in some instances and they might approve it. You just never know.

I'll direct you to our Viekira Pak thread. There you can find posts from others that went through treatment on it. The best advice for any of these new all oral treatments is to adequately hydrate. People that fail to drink 3-4 liters of water everyday tend to experience worse side effects, like headaches and fatigue. For the most part, the side effects are minimal.

Others will be along to welcome you shortly. If you need anything, don't hesitate to ask.

Viekira Pak Train

Canuck · Guru

Hi Cheech,

I am sure helpful advice will be forthcoming here, but it would be helpful for us to know a wee bit more about your HCV.

I am assuming you are a GT1, and assume you are treatment naive? - but not knowing anything else about you and your condition, makes it a hard to take into consideration all factors. Like ... if you are young, how long you have had HCV, your Fscore, the condition your liver is in, what your sub-type may be, and whether you are relatively healthy otherwise. How long have you been waiting for treatment, what is your viral load, have you had a fibroscan and abd. ultrasound, is your your A/B and flu immunity up to snuff?

Without knowing anything more, if your doc was leaning to Harvoni as his first choice, then I too would be disappointed that his first choice was declined. Good on them then (your doc and pharmacy), that they have already started the appeal of the declined Harvoni. Did you and your doc ever discusss "pan" Epclusa as a treatment option?

Do share more info if you will. Others I am sure will pony up with thoughts on your matter . smile C.

Cheech · Member

Just received word that Blue Cross Blue Shield denied my doctors request for Harvoni. What a bummer. I believe they did approve Viekira. What research I was able to do is that 8 weeks of Harvoni was less than the 12 weeks of Viekira. My doctor felt and in his experience that 8 weeks of treatment zapped the virus out. I guess BCBS is cheaping out but they should way what the most likely cost will be. My doctor and specialty pharmacy is making an appeal on the Harvoni decision.

Any feed back on the Viekira side effects or the effectiveness? What I had seen is the treatment for both are in the 95% success rate.

Thanks,

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