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Medicaid and Hep C Medication
Hi. I am new here and have always been a reader of the forums. Everyone always has great information to offer. I have my first appointment on the 14th of April to see a doctor about my Hep C. My only insurance is medicaid and I'm concerned that being on state insurance they will want me to take the less expensive medication with harsher side effects. Can anyone help me with this? I just want to know what I can say when I go in and if I still have the option to ask for one of the newer medications being on low income insurance. Any information would be greatly appreciated. Also is there a place on the forums or on the web where I can be referred to a good doctor in my state if I need to search out a different doctor?
The only approved drug for people with medicaid in Tx. that have a diagnosis of Hep C is Sovaldi, and then you have to have a METAVIR score of at least F3, you must have a Rx. written by a specialist, either infectious diseases or gastroenterologist, must have a neg. urine drug screen within 30 days of receiving medication (before they will approve it). I had almost complete organ failure 15 yrs. ago before I even knew I had hepatitis C, was given 3 yrs to live (5 with dialysis) my gastroenterologist gave me no hope (as I had NO insurance) I wrote to Schering pharmaceuticals telling them my situation, volunteering for clinical studies , as the only treatment then was still experimental (combination of ribavirin and interferon injections) although the injections made me feel sicker than I did with the hep c, I kept telling myself "it can't feel much better to die". after 7 months of being bedridden, hair falling out and so anemic hgb 8.1 I finally cleared the virus. Only thing is I have recently relapsed and since my liver isn't in that bad of shape anymore or 'yet' medicaid won't approve treatment. Makes no sense to me. Are they waiting for us to just give up and die? Otherwise the extra costs that come with advanced liver impairment come into play;ie;permanent liver damage, dialysis, less likelihood of complete recovery, etc. not including the chance of passing it on to someone else?! If I thought I could tolerate the interferon injections I would just ask for that treatment again..if you have no insurance and meet income requirements (low income) Gilead (makers of Sovaldi) are very helpful, a friend of mine received the medication while waiting the 24 months to receive his medicare .The treatment regime is Sovaldi and ribavirin 12 to 24 wks depending on genotype.
2 Comments
I have a friend that is draining his parents of money because he says every time he goes to generations in Willimantic CT it costs money for this Hep c pills. He has husky state insurance isn't he covered?
You should probably start a new thread rather than adding to the end of a conversation started in April 2015. That way your question will be noticed.
That being said there are many insurance companies that try to restrict access to hep c meds because of the cost. I have no idea about the specifics in your friends situation but Harvoni for example costs $1,125 per pill so for a typical 12 week treatment that would be $94,500. However, people can appeal a denial and many are later approved also there are other resources like the patient assistance network.
I would think he should be receiving a one month supply at a time so about $31,500 per one month refill at retail costs.
Please start a new thread if you have any further questions
That being said there are many insurance companies that try to restrict access to hep c meds because of the cost. I have no idea about the specifics in your friends situation but Harvoni for example costs $1,125 per pill so for a typical 12 week treatment that would be $94,500. However, people can appeal a denial and many are later approved also there are other resources like the patient assistance network.
I would think he should be receiving a one month supply at a time so about $31,500 per one month refill at retail costs.
Please start a new thread if you have any further questions
Hi everyone. The Doc took 18 tubes of blood from me and tested all sorts of stuff including HIV which is good. The nurse told me he is extremely thorough They finally called today. I know I am genotype 3 which I'm afraid Harvoni might not be in the cards for me from what I read but if anyone else is the same or can tell me the difference I'm all ears. She said the viral load was hard to read? So unfortunately I don't know that yet. I go for an ultrasound on May 4 and since I had a biopsy done back in August he wants me to have that faxed over to him. I think that is really all the info I have right now. I want to say thank you again from the bottom of my heart for all of the help you have all given.
I am posting the links to some articles on the necessity of biopsy because it seems to be a very controverisal topic here at Medhelp. Perhaps some of these articles may give you another way to look at the topic. Or perhaps it will make some of us more confused than ever. I tried to find very balanced arguments both for and against. My personal concensus is that in some patients it is necessary and in some cases, where the patient wants to be treated no matter his stage of liver disease, it is unnecessary.
In conclusion, all patients with chronic hepatitis C who are candidates for antiviral therapy may not need to undergo a procedure for which there is much apprehension, a finite complication rate, and personal and societal costs. Some clinicians are moving to selective rather than routine use of liver biopsy in patients with chronic HCV infection, reserving biopsy for circumstances in which biopsy would influence the decision regarding either initiation or continuation of therapy.
http://www.hcvadvocate.org/hcsp/articles/Keeffe-1.html
...................................................................................................
Noninvasive Tests Reduce Need for Liver Biopsies in Hep C
“Noninvasive diagnostics are more advantageous to the patient as there are no serious side effects and they may be more cost effective when compared to liver biopsy, although this remains to be determined,” Talwalkar says.
Talwalkar stresses, however, that liver biopsies still have their place in diagnostic care. “Fibrotest or elastography imaging are helpful to confirm cirrhosis or minimal to no fibrosis. Liver biopsy may still be necessary to determine stage of fibrosis in those patients where noninvasive techniques were indeterminate.”
http://www.hepmag.com/articles/hepatitis_biopsy_fibrotest_2501_20603.shtml
........................................................................................................
Liver disease staging
Liver biopsy is the best method for staging the degree of fibrosis (typically staged from 0 to 4 with the METAVIR, and 0 to 6 with the Ishak scoring system) and grading inflammation (typically graded from 0 to 4) [22, 24] . In most cases, patients who initiate antiviral treatment for HCV should have more than portal fibrosis (greater than stage 1). Although liver biopsy is the preferred approach, it is invasive, is subject to sampling error, and carries a risk for severe complications [24] . As such, it is not required before reaching a treatment decision, and may be less useful among patients in whom the results are unlikely to alter management [18] . Alternative approaches, such as liver imaging and serum fibrosis markers, can be performed instead of a liver biopsy, although with careful recognition of their limitations [25, 26, 27, 28] .
http://www.hepatitis.va.gov/provider/guidelines/2012HCV-single-page.asp
In conclusion, all patients with chronic hepatitis C who are candidates for antiviral therapy may not need to undergo a procedure for which there is much apprehension, a finite complication rate, and personal and societal costs. Some clinicians are moving to selective rather than routine use of liver biopsy in patients with chronic HCV infection, reserving biopsy for circumstances in which biopsy would influence the decision regarding either initiation or continuation of therapy.
http://www.hcvadvocate.org/hcsp/articles/Keeffe-1.html
...................................................................................................
Noninvasive Tests Reduce Need for Liver Biopsies in Hep C
“Noninvasive diagnostics are more advantageous to the patient as there are no serious side effects and they may be more cost effective when compared to liver biopsy, although this remains to be determined,” Talwalkar says.
Talwalkar stresses, however, that liver biopsies still have their place in diagnostic care. “Fibrotest or elastography imaging are helpful to confirm cirrhosis or minimal to no fibrosis. Liver biopsy may still be necessary to determine stage of fibrosis in those patients where noninvasive techniques were indeterminate.”
http://www.hepmag.com/articles/hepatitis_biopsy_fibrotest_2501_20603.shtml
........................................................................................................
Liver disease staging
Liver biopsy is the best method for staging the degree of fibrosis (typically staged from 0 to 4 with the METAVIR, and 0 to 6 with the Ishak scoring system) and grading inflammation (typically graded from 0 to 4) [22, 24] . In most cases, patients who initiate antiviral treatment for HCV should have more than portal fibrosis (greater than stage 1). Although liver biopsy is the preferred approach, it is invasive, is subject to sampling error, and carries a risk for severe complications [24] . As such, it is not required before reaching a treatment decision, and may be less useful among patients in whom the results are unlikely to alter management [18] . Alternative approaches, such as liver imaging and serum fibrosis markers, can be performed instead of a liver biopsy, although with careful recognition of their limitations [25, 26, 27, 28] .
http://www.hepatitis.va.gov/provider/guidelines/2012HCV-single-page.asp
Jaz, DWBH is absolutely correct. Biopsy has been the gold standard. As for it's accuracy, it has a 30% sampling error so it isn't always all that accurate. In the past, when interferon and ribavirn were the only drugs available. biopsy was more important for many reasons. One reason is that the majority of people with genotype 1 didn't respond to treatment, so docs wanted to know just how bad a person's liver was. Today, with treatments that are curing the majority of patients, some hepatologists feel that even the small risk of biopsy, just isn't worth it. The likely scenario is you can treat, cure, and over time your liver can heal. Besides, most doctors do not need a biopsy to tell if a person is cirrhotic. There are things that show in the physical exam and lab work that make it pretty easy to diagnose. A cirrhotic liver feels hard on palpation. Patiens often have spider nevi and even more te4lling is that citrhotics often have low platelets and even low red and white blood cells. The only caveat to all of this is that your insurance may insist on a biopsy to approve treatment since many companies will only pay for people with Stage 3 or 4. But even then, if you have insurance and it won't pay, the makers of the drugs will often help financially. So, if you still feel you don't want a biopsy, speak to your doc...he may or may not agree with you.
Biopsies see more accurate than fibroscans. Fibroscans are good at diagnosing F-1 (minimal liver damage) and F-4 (cirrhosis). In between or mid range...lack accuracy. There are few fibroscans in the United States.
Most beings in large cities. And even then only one per city.
Hope this helps
Most beings in large cities. And even then only one per city.
Hope this helps
Many of the doctors are not doing biopsies any more as the treatments are so successful they feel why put the patient through it. You might want to ask the doc if you could have a fibroscan which is noninvasive.
Those are extremely helpful questions. Thank you so much. I am so happy that I found this forum. I don't have anyone else to talk to about this so it's very nice being able to come here and find answers to lots of my questions. You all are some really great people. God bless you all.
Hi, jaz: Here is a list of questions that Someone on the Forum posted. From these, you can pick and choose, and add others.
Good luck on that appt tomorrow!! Pat
Do I need to be vaccinated for hepatitis A and hepatitis B?
What is my genotype? What does my genotype mean?
Do I have liver damage? If so, how much liver damage is there?
What are my treatment options?
Is there one treatment you think is best for me?
Are there any clinical trials?
What are the benefits of each treatment option?
What are the potential risks of each treatment option?
How can I protect the people around me from hepatitis C?
Do I need to start treatment for hepatitis C now?
How will this treatment interact with my other medications?
How will you assess whether the treatment is working for me?
What should I do if I have side effects? How can I manage the side effects?
What are symptoms to pay attention to and look out for?
How likely is it that I will develop cirrhosis or liver cancer?
If I do not start treatment now, how often should my liver be monitored for liver damage?
How often should I see a liver specialist? Primary care physician?
Good luck on that appt tomorrow!! Pat
Do I need to be vaccinated for hepatitis A and hepatitis B?
What is my genotype? What does my genotype mean?
Do I have liver damage? If so, how much liver damage is there?
What are my treatment options?
Is there one treatment you think is best for me?
Are there any clinical trials?
What are the benefits of each treatment option?
What are the potential risks of each treatment option?
How can I protect the people around me from hepatitis C?
Do I need to start treatment for hepatitis C now?
How will this treatment interact with my other medications?
How will you assess whether the treatment is working for me?
What should I do if I have side effects? How can I manage the side effects?
What are symptoms to pay attention to and look out for?
How likely is it that I will develop cirrhosis or liver cancer?
If I do not start treatment now, how often should my liver be monitored for liver damage?
How often should I see a liver specialist? Primary care physician?
I definitely will. As you can tell, my nerves are getting to me. Trying to overdo my reading on the net. I want to make sure I ask the right questions. I think I am most scared of a liver biopsy. But I will be here tomorrow to let you know what I have found out. :)
Sovaldi.com is a very good place to start. If you have questions after reading
straight from the source.......ask here.
straight from the source.......ask here.
Please come back and tell us your experience with the doctor. I have heard he is very good but don't know from personal experience.
Which drug gets prescribed for you depends on your genotype. Most people are genotype 1 and both Harvoni and Viekira Pak are appropriate. Since you are treatment naive and if your viral load is below 6 million, Harvoni for 8 weeks would be great. Viekira Pak is more pills and is given with ribavirin. Both are successful treatments. If you have to have hep C you certainly got it at a great time. Unfortunately, many insurance companies will only approve one treatment over the other so docs may not be able to prescribe the one they prefer. For example, those with ConnectiCare (HMO3T) will only be prescribed Viekira Pak and you must be stage 3 or 4.
I hope you like Dr. Wu.
Which drug gets prescribed for you depends on your genotype. Most people are genotype 1 and both Harvoni and Viekira Pak are appropriate. Since you are treatment naive and if your viral load is below 6 million, Harvoni for 8 weeks would be great. Viekira Pak is more pills and is given with ribavirin. Both are successful treatments. If you have to have hep C you certainly got it at a great time. Unfortunately, many insurance companies will only approve one treatment over the other so docs may not be able to prescribe the one they prefer. For example, those with ConnectiCare (HMO3T) will only be prescribed Viekira Pak and you must be stage 3 or 4.
I hope you like Dr. Wu.
Ok just ignore my reply Dee1956. I answered questions before reading the rest of what you wrote. Thank you for all of this information. I wouldn't have had a clue as to where I should look for any of this. I am actually going to see Dr Wu (AWorriedMom posted above). He's at UConn. I definitely will come back here and let you know how my first appointment went. I know that once I know more about my liver condition that will probably have a lot to do with which medicine I'm prescribed correct? I think I read somewhere that Harvoni is only for certain levels? Sorry for sounding so new and uninformed. This is why this is the best place for me to be right now. :)
Thank you so much. Sorry I wasn't able to come back online and reply sooner. This was very helpful. I'm anxious to get to the appointment Tuesday morning and get more information and see what will be available to me. I contacted someone at Support Path also and she gave me an intake form to bring with me to my appointment and told me steps to take if my insurance doesn't approve my medication. Thank you so much for your help.
The link was helpful, Iit looks like you have to have seen a Hepatologist or Infectious disease doctor in the past 3 months if another doctor is writing prescription
Have to be either F3 or F4 and must have imaging results or biopsy to prove it.
Can only get prescriptions 2 weeks at a time.
I guess Ct is one of the states that has the added restrictions at this time. They are working on this deal that should be approved in the next few days which will really help people in CT
At least it is moving forward.
Have to be either F3 or F4 and must have imaging results or biopsy to prove it.
Can only get prescriptions 2 weeks at a time.
I guess Ct is one of the states that has the added restrictions at this time. They are working on this deal that should be approved in the next few days which will really help people in CT
At least it is moving forward.
Thanks for the link. It looks like the state of CT will be getting the deal very soon.
I am glad things are moving ahead.
I am glad things are moving ahead.
It really depends on the current condition of your liver. See your doctor and
get that information. Here is a recent list of the drugs covered in CT.
http://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/CT_PDL_medicaid.pdf
Here is the requirements for your state to obtaining better treatment other than what is on the list of Medicaid Drugs.
http://www.huskyhealthct.org/providers/provider_postings/New_Hepatitis_C_Prior_Authorization_Criteria-Sovaldi.pdf
Its very important to have information you need like your genotype and results of a liver biopsy. If you don't know these things then see your doctor and get this information. You can't do or find treatment without that information.
Get back with us and let us know the results. Maybe by then there will be
new information concerning the approval of drug treatment for Medicaid patients.
Your first appointment is next week. Looking forward to hearing from you.
get that information. Here is a recent list of the drugs covered in CT.
http://www.ctdssmap.com/CTPortal/Portals/0/StaticContent/Publications/CT_PDL_medicaid.pdf
Here is the requirements for your state to obtaining better treatment other than what is on the list of Medicaid Drugs.
http://www.huskyhealthct.org/providers/provider_postings/New_Hepatitis_C_Prior_Authorization_Criteria-Sovaldi.pdf
Its very important to have information you need like your genotype and results of a liver biopsy. If you don't know these things then see your doctor and get this information. You can't do or find treatment without that information.
Get back with us and let us know the results. Maybe by then there will be
new information concerning the approval of drug treatment for Medicaid patients.
Your first appointment is next week. Looking forward to hearing from you.
George Y. Wu, M.D., Ph.D.
Director, Hepatology Section and Herman Lopata Chair in Hepatitis Research
Viral hepatitis, chronic liver disease, screening colonoscopy, ultrasound-guided liver biopsy, ultrasound-guided paracentesis. UConn.
I can find out who is the best doctor in CT. I would normally say Yale but not positive.
Well...duh, I looked at your status, see you are in CT, found an article that I hope helps you. Ct is in the process of striking a deal with manufacturers so I think that you should be good to go depending on your geno type
http://www.wsj.com/articles/states-work-to-strike-deals-for-hep-c-drug-discounts-1422492687
http://www.wsj.com/articles/states-work-to-strike-deals-for-hep-c-drug-discounts-1422492687
Hi here is a thread with some Medicaid information. If you could tell me state I can look
http://www.medhelp.org/posts/Hepatitis-Social/The-Medicaid-Debacle/show/2528484#post_12368133
http://www.medhelp.org/posts/Hepatitis-Social/The-Medicaid-Debacle/show/2528484#post_12368133
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