Harvoni not approved

[flyinlynn]

Hi all

Just called express scripts automated line. My request for Harvoni was not approved. Stayed on the line to speak with a representative. The woman reading me the denial could not pronounce any of the med names even had to sound out how to say peg interferon.

Waiting on my denial letter and appeal from my doctors office.

Dang
Lynn

[can-do-man]

Thank you AWorriedMom for your post as you are exactly correct. It is as you say... Interferon = platelets and Ribavirin = HGB levels and there is no issue with us cirrhotics and Ribavirin. Been trying to get this across several times here and in other posts before. So don't feel bad about being ignored just keep letting the truth out so others that read get the correct info... Best to you

[flyinlynn]

Hi can do and a worried mom
Sorry if I offended either one of you fine people. I wasn't ignoring your thoughts and apologize if it seems so.

I guess I have some tunnel vision perhaps having my eyes on the price of Harvoni and seeing a slightly higher number there. The number I found was for GT 1a non responders but of course samples are small and actual results will vary.

Ok the riba won't kill me then I guess lol. So if I have no other choice it is what it is.

Just a few thoughts still, Harvoni is available now for one, and does have a good profile regarding trial results and side effects reported. Also my doctor has decided Harvoni is a good choice for me medically but now the bean counters are making patient care decisions by overfruling a doctor which does seem strange to me.

Once again my apologies to both of you just my frustration coming out I am sure you both have a good one

Lynn

[FRED220]

I  can relate to  how you are feeling because I am in the same boat and I want HARNOVI. I truly believe we will be able to get Harvoni, I think BCBS
is going to get things corrected and you and I will :))) i will keep you informed of whats going on after the 17th meeting. have a great day!  

[Dee1956]

Hey there! I understand how you must feel, the Harvoni is out there now.
Unless I misunderstood, it seemed like a very short time between your doctor submitting you for approval and your denial.
I hope you know I was trying to be supportive.
I wish you the best.
Dee

[tobila]

Hi Lynn,

I may be preaching to the choir here and telling you what you already know, but here's my two cents.
First, I am on Harvoni now, but was initially denied because BC did not have an electronic image of my liver. Don't know why they denied the claim rather than ask for more info, but, once they got what they asked for, they did approve my claim.
So perhaps the first denial is more like an opening chess move than a final statement.
Second, APPEAL, APPEAL, APPEAL (IMHO). Approxiamately 70% of health insurance appeals are granted. In writing, get a paper trail, be persistent, and get help. People on this forum says good things about Support Path, for a start. The Patient Advocate Network has some excellent, step by step guides as well as volunteer caseworkers. The Jennifer Jaff center helps with appeals too.

http://www.thejenniferjaffcenter.org/advocacy/health-insurance/how-to-file-insurance-appeals/

http://www.patientadvocate.org/help.php

You will prevail and I hope it will be very soon>

[can-do-man]

No offense taken. I truly understand where you are coming from. As a prior relapser that is also cirrhotic time is not on our side. Harvoni  in trials has had great results and if your doctor thinks that is your best bet and you have full trust in him then do everything you can to get it.. My only point on ABBvie is it's not that far away, not like it was when we had to wait years for the PI's and then the long wait for S/O.

I remember all the hype about S/O and how everybody just had to have this "miracle" drug as it was going to cure everyone. Well as we have seen here that's been far from the case across all genotypes. Now it's Harvoni. As we know trials are very much "cherry picked" and for a reason but when they hit the open market things don't turn out quite the same.

I also know there seems not to be any Sovaldi resistance but it is still going to be one of the drugs that have proven not to work with some people. Myself I think 12 weeks for people in your case was just not long enough, besides being cirrhotic you were a prior null responder. So I fully agree 24 weeks would be your best bet with Harvoni.

One thing I really wish you the best, Hep C and cirrhosis is not a good place to be in... Keep up the fight and don't give in to them.