Does Highmark BCBS PPOBlue cover hcv treatment

I have hcv genotype 1A and was wondering what treatments highmark blue cross blue shield ppo blue covers.  I called the company but they can't tell me what they cover unless i ask for a specific service.  I just wanna know if they cover ribavirin and interferon combination therapy before i ask my doctor to put me on it.  Anyone know?

[nygirl7]

They certainly should it's a very expensive but typical medication and what we are all prescribed for treatment.  You'd need to ask them if they will pay for interferon (Pegasys or PegIntron) and ribavirin both as that is the currect standard of care medications. I just can't imagine any insurance not paying.  My insurance had a $40 copay per month for both meds. Not too bad. Of course if you are denied there are patient assistance programs that likely could pay for the meds. All they really ask for is how much you make (which is not nearly as low as you would think!) and a copy of the denial letter.

Has your doctor done a biopsy yet? do you know if you have advanced liver damage and need to do treatment? There are several drugs in the pipeline that might be passed through the FDA in the next year or two that make treatment duration shorter with better odds of success.  If you don't need to treat right now you could look into waiting for them (although me personally once I knew I had it I wanted it gone no matter what!).

The biopsy sounds dreadful but is the best way to find out where you stand. Treatment isn't impossible but it's not fun.  Mostly you have to look at it as having a start and end date and realize it's not forever.  If you get too hung up into what "might" happen or what side effects you "might" get you can really botch yourself up - staying optimistic and not focusing on those type things is the best way to get yourself through the 48 (typically) weeks.

[Bill1954]

Nygirl makes a good point; if you’re refused for some reason, call the mfgr’s patient assistance program and tell them what happened; most likely, they’ll cover the cost of therapy for you. I’ll go ahead and give you the numbers for them just in case:

Pegassist (Roche Pegasys system): 1-877-734-2797

Commitment to Care (Schering- Plough PEG-Intron system): 1-800-521-7157

Let us know how it goes, and take care—

--Bill

[carol411]

I have blue cross blue shield.  My first pegasys and ribaviron was ordered through a local pharmacy at $606 copay for the pegasys and $50 for the ribaviron.  I looked on the blue cross blue shield web site and found I could have them sent to me through their preferred pharmacy for a $69 copay for pegasys and no copay for ribaviron.  Hope my experience saves you a lot of money!!  There's a number to call to get the fax number to give your doctor to send in the prescriptions.

Welcome and good luck!

[Trinity4]

I have BCBS and all my drugs, office visits and tests were covered 100% after I met the
$1500 deductible.  Of course, coverage depends on what type of policy your employer offers but BCBS PPO's are pretty good about paying.  HMO's not so much.

[jelise]

I have BCBS basic (PPO) insurance.  Once the GI prescribed the meds, I got some sort of pre-approval.  My meds were delivered to me once a month by a company called Metformin.  I had a $45 copay which they just let me pay over the phone when they called to set up delivery every month.  Metformin was great - my meds were always on time and in good shape.  I had a $30 copay for the GI (who I only saw twice), but the monthly labs were free.