INSURANCE WONT PAY FOR INTERFERON

HI, I am trying to find out if there are insuance companies that cover interferon treatment if the patiet has normal enzyme levels. I have normal ezyme levels,stage one scaring level 2 inflamation (inflammation), chronic fatique , 19 mil viral count. my Dr. want to treat but my ins CAREMARK wont pay because my enzymes are normal. ,,,,,thanks,,,derek

[Mister beagle bailey]

Hi and welcome,
Your Dr. said you have Hep C and the ins. co. won't pay, I've never heard of any thing like this.  This makes me so mad, these ins co. need to be held accountable.  Yet it seem no one is watching.  I feel so bad for you and can't imagine what you must be going through.  Is this ins. through your job or do you pay for it your self? Did your Dr. report to them you hve HepC?  There is a program for those who have no ins. through the drug co. that makes it.  They may cover those who was denied treatment, it was posted here awhile ago but I can't remember the name.  Someone will come on and probably will know the info on it.  In the mean time I will try and fine it for you.

Hang in there, there has to be an answer to this.

            The Beagle

[dptile]

thanks for responding, the ins is through my wifes work primary ins is united healh care and rx is caremark. i havnt been able to work much because of the fatigue and related problems but my wife makes a good income which disqualifies us from other programs.

[fl-sam]

Hey,
Sorry to hear about your insurance problems.  My insurnace company initially said they wouldn't pay for interferon because it was a drug that had to be injected (have no idea what that had to do with anything).  After some badgering, however, they relented.  My insurance coverage ended in January, though, so I contacted the schering commitment to care program about providing medication.  The phone number is 800-521-7157.  They are currently paying for 100% of my peg-intron and ribaviran.
Give them a call if you can't work out the problem with your insurance.  It only takes a couple of weeks for them to review your information and let you know if you are eligible.

Good luck,
Sam

[cao]

I'm insured through Great West & didn't have any trouble obtaining authorization despite a history of completely normal enzymes & favorable biopsy readings.  There isn't a perfect correlation between healthy enzyme levels & the absence of liver damage.  Perhaps you could ask to speak with someone higher up the Caremark foodchain & present them with some research.  Perhaps your physician would be willing to make calls on your behalf?

[Mister beagle bailey]

I was just trying to find this info in the old threads.  Thanks so much for posting this for dptile. I felt bad, can't imagine someone not being able to treat because of a ins. co. unwilling to pay.

                        Beagle

[cquest]

I've said it before, be a royal pain and I bet the ins. co. will change their tune...That sounds like a stalling technique to me...It could be the docs fault for not being as specific as they should be...I would start w/ the docs office and see what they say, then call the ins. co. and throw words around like 'State Insurance threat' "Attorney General complaint' etc, whoever regulates the insurance industry in your state. The ins. co's are terrified of those complaints because the state keeps track of them (here in NYS anyway) and they get fined! I used to work for United Healthcare so I know...Good luck!

Yeah Beag, been layin' low for a while...no reason really, just takin a breather...

Cin

[Mister beagle bailey]

Your right, I forgot about that - brain fog.  Hope your feeling fine.  Have a great day.

   Beagle

[who_is_this]

They will often deny you at first.  Appeal, have a letter from your doctor and I'll bet they will reverse their decision.
They hope that if they deny you'll drop it.  Many people do.

Squeaky wheel gets the grease.

[harty29]

Appeal.  I have the same insurance company and one appeal letter from me is all it took.

[NYgirl]

There are people in here who get their meds for free from the drug companies.

As long as the insurance pays for your tests and things maybe you can contact the companies and get your medications for FREE that way?

I just saw  a commercial on tv for something called PPA and they said they help pay for prescriptions.

I believe the site was www.pparx.org I will try to find it. I had never heard of this before but that mght be help for you too!

[Fisheress]

Is a major drug provider putting profits before your health?


KHOU-TV

Caremark prescription
The 11 News Defenders have found that's what some critics are claiming.

It's a business that services millions of prescriptions here and across the country.

Some patients told 11 News Defenders they're simply not getting what the doctors ordered.

They write you a prescription for a drug you need and you get it filled.

Seems simple enough, right?

Not according to former insiders of a multi-billion dollar company.

Also online

Part II: What did a major drug provider do with returned medicines?

Part I: Is a major drug provider putting profits before your health?

Caremark statement to 11 News

Robert Garis biography
They say what happens next to some patients is hard to believe.

YOU WILL HAVE TO SIGN INTO KHOU TO WATCH THIS VIDEO WHICH MAY BE VERY INTERESTING TO ALOT OF YOU WHO USE CAREMARK! THIS IS QUITE AN INVESTIGATION!

http://www.khou.com/news/defenders/investigate/stories/khou060206_cd_defenders10.132b8cc.html

[anise]

That is very strange Caremark won't pay!  We have UnitedHealthcare and Caremark is our prescription drug company.  They paid for my treatment!  It doesn't seem like them to not pay.  It took me 1 1/2 weeks from the time my doctor called in the prescription to get it filled.  Have you call them yourself?  Is it possible your doctor is not filling the prescription correctly?  By the way, Caremark has a program devoted just for Hepatitis C.  I would keep after them.

[anise]

This is interesting!  I am definitely going to call my doctor tomorrow regarding this.  My husband's company just had Advance PCS bought by Caremark.  Thanks for the information, I really appreciate it.

[Dale_Ray]

My insurance company began immediately with the argument of not paying for injectables. After many phone calls and intense moments I was able to work up the chain of command to the supervisors and got the approvals (in writing always). Insurance companies operate under a entirely different set of moral standards and if they can screw you they will. State Farm is not like a good neighbor, nationwide is not on your side and your not in good hands with Allstate. Don't take their first no to mean no. Why would you primary coverage discriminate against your medication and its delivery system (injectable).Dale

[antman]

i have Great West too. so far they have been really good about paying for my tests.I am gearing up for tx this year. i see Pegasys is on the GW formulary and the Dr. said they would mail the drugs to the house. i have a question for you. how much is your co-pay and is GW good about paying for the anemia helper drugs(if necessary). just wondering what i can expect.BTW- i am also a 1/2 with only very slightly elevated enzymes. it's the bx and the vl that count. the Dr's all said normal enzymes can occur even in cirrohsis, it's not the major factor and has little to do with damage. thanks.

[NYgirl]

It's good to see you around again.  Since our fun post on "fine dining" I thought you got so grossed out you had decided never to come back.

;-)

[GoofyDad]

Since our fun post on "fine dining" ...

I guess when your dietary staples are fudge pops and frosted flakes, a little fresh (or not so fresh) protein can look pretty tasty, huh?

Hey I wonder what that frosting on the frosted flakes is anyway, and whether that has anything to do with why Tony the Tiger always feel so GREEEEEEAAAAAAAAT~!?!

[antman]

me? grossed out! impossible. that subject was the last thing to get me posting, it was so fun. i'm still not convinced it was a real post. and i wanted more details! i'm still planning on tx this year and read mh daily.hope your feeling better.
antman

[NYgirl]

LOL I agree it sounds like it was made up by some kid sitting at home having fun......but if it WAS real I would have LOVED to hear the response (well I would loved to have heard how it happened even if it WASNT real).

That was one of the funniest things I ever saw in here and it really did make our day.  We are some siiiick people in more ways than one hhahaaa.

[cao]

I paid $50 per shipment of ribavirin & interferon and received the drugs in two, three-month supply shipments (I'm a 2, so only 6 mos. of tx).  They came straight to my door in coolers & did require my signature.  Oddly, even after my six month stint was up, the pharmacy connected with GW kept trying to set up delivery of more drugs.  In a day where insurance companies are notoriously stingy, mine was a little overly generous!  I really felt well taken care of by the folks at the pharmacy associated with GW - they even made a point of reminding me that there were pharmacy nurses available to answer medication related questions at any time.  

Best of luck to you!  I remember being horribly overwhelmed when I was in your shoes, but 1.5 years later, it was all worth it:)

[anise]

Thanks for the information about Caremark.  I listened to the video!  My doctor's office is closed today, so I called the Caremark pharmacy to ask them why they sent me the generic instead of the original product.  They said my doctor approved the generic (I will ask my doctor tomorrow), and that there really is no difference between the generic and the original product.  (In my opinion, that remains to be seen, since the generic has only been around since november).

I also asked about the federal investigations regarding their company.  The pharmacist said that was 5-6 years ago, and that now they have all sorts of compliance strategies, classes for the emplyees, etc.  In essence, since they are in the public eye there are above board.  (Above board, I say, hopefully).

[antman]

thanks cao.thats not bad at all. now it's pretty much narrowing down when to start. i'm a 1a so i have a year tx.i'll let you guys know when i decide.one more thing. i got a box from my Dr. from Roche. it has this gel thing that looks like it goes over your eyes. just what is it for and do you heat it in the microwave or what? i don't wanna blow it up or something.
antman

[can-do-man]

anise says...Thanks for the information about Caremark. I listened to the video.
________________________________________________________________

Now don't qoute me on this. But i think them there videos are to be watch. Could me wrong though. Best of luck to ya

[NYgirl]

I have no idea what is in that box I never got one so it sounds like another dinner story to me ;-)

Seriously - best of luck deciding when to start. I personally just said ok I'll start the week after the kids to to school...seemed logical but used no other real criteria.  When you are on it as long as we are (I am 1A and 1B both) well.....one week either way or one month either way.........who cares.

Just make sure you start that is all that is important. Oh yeah AND that you kick the Cr8p out of those buggers!

[anise]

You are correct, and I chose my words carefully.  I was only able to listen to the video, for some reason I could not see it :)  Good catch though.

[Fisheress]

This investigation is not that old.  Maybe a few weeks?  Watch this one too......VERY SCARY!!

Did a major drug provider send you medicines that should have been destroyed?

Also online

Part II: What did a major drug provider do with returned medicines?


That is why experts and insiders say they're shocked the company sent some patients drugs that other customers had their hands on first.


KHOU-TV

Is this what your doctor prescribed?
We have also learned that attorneys general from 19 states are looking into Caremark's business practices for what's been described to us as a "broad consumer protection investigation."


http://www.khou.com/news/defenders/investigate/stories/khou060207_cd_defenders10.61dfe36.html

[fishdoc]

Its pretty scary stuff.  You have gotten lots of good advice here.  I have a good friend who's uncle taught Grisham law, and the prof. character in the rainmaker is based on him.  He categorically believes there is money to be saved saying no.  50% will drop it then, the other 50% will protest.  Of those, 50% will drop it the second go round.  The best defense is a good offense.  READ YOUR POLICY, put together a nice letter with quoted verbiage, and put a cc on the bottom: to every legislative entity in the book.  Send it registered mail.  Its amazing how panicky invoking a senator makes people.  I strongly suspect your covered, because most companies do cover it, and others here seem to have the same company.  This constitutes minor b*tch mode!!!!

[Fisheress]

Not only that but anyone here that goes thru Caremark and had their Riba subsituted with a generic, the video also explains that too.  I know alot of you had this switch done to them

[aron1]

i have hep c type 1a and currently have ins from work however i was laid off rate before im starting treatment,if two months into my treatment my insurance drops me what do i do then,thanks aron frazier