Paying for 72 week treatment

I'am about to complete my 48 week treatment and because of my viral response want to continue for 72 weeks. Does anybody know if your current medical insurance will pay for the extra 6 months? Mine is Etna and they gave me a really hard time with the 48 week approval.

[Isobella]

I can't answer your insurance question, but below is a list of prescription assistance programs that may be helpful.

Good luck with the insurance and tx :-)


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

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

Rousch Pegassist Resource Center  877-734-2797

Healthwell Foundation  800-675-8416

Chronic Disease fund 877-968-7233

Shared Solutions  800-887-8100

Mnord  800-634-7207

Free procrit, call 1-800-553-3851

Just go to www.procritline.com

[can-do-man]

Seen it go both ways here, my best advice is to get on it early. While mine didn't give me a problem i did have Commitment to Care ready to step in if they had. Their pretty liberal on their income limits and easy to work with. Best to you

cando

[IAmTheWalrus]

Can't say about the insurance. I assume that your doctor thinks 72 weeks is necessary. He's the one that can make a medical argument to the insurance company.

72 weeks is pretty standard for geno 1 patients who are not UND by week 12, but do achieve a 2Log viral reduction. The longer treatment improves their odds of SVR considerably, as a group. There are good study data to support this.

My insurance gave me no problem about going from 48 to 72 weeks.

If they deny you, you should be able to appeal. Hopefully your hepatologist can help you do this since there are good data and studies to support. Getting started early like Can-Do says is a good idea.

Best luck - Brent

[FlGuy]

I have Aetna and was prescribed to be on treatment 24 weeks more than 'standard'.  Insurance plans can differ, even within the same insurance company.  One of the main objective of insurance is to limit pay-outs for coverage as much as possible. However, you and the docs can work with insurance company.  If extended treatment is warranted, you might want to get your doc on the case with the insurance company.  Insurance will likely want to know the 'why' and have it demonstrated with things like lab results, prognosis, response to the med etc.  This is a situation that can be worked, it will require some work and diligence on your par and the doc's part. Work the situation as soon as you can so that spped bumps don't cause an interruption.

[nygirl7]

I have Aetna and they would not approve my extension however this was a long time back before it became more commonplace. They said it was "experimental" jerks.

Anyway I used Peg-Intron and Comittment to Care paid for all of my peg and riba for the entire extension for FREE.  Aetna did continue to pay for all the doc appts and other scripts.

I'm not sure which interferon you are using but the drug companies are very good about making sure the extending folks get their meds. You first need to just be denied by Aetna and then contact them and they will immediately set you up with meds as soon as your doc sends them the script. Then they will worry about finances etc (it's pretty leniant, I make a pretty good living and they approved me) and give you a month supply of the meds while they do all the approvals.


PS I have been SVR for almost two years.........extending is definitely the way to go if you were not UND at week 12 but were by week 24.

Good luck.