Start treatment and have surgery

[Faithdove]

My husband is seeing doc next week to hopefully start treatment with the newly approved Sofo with RBV and INF. he has issues with his shoulder and thinks he can get surgery for that while starting this treatment. I do not know yet if his doc will prescribe this regimen and even if his insurance will cover it. (Express scripts). From all I have read, for his Hep C genotype 1a, he is going to have to get the INF regardless. Sooooo.....what do you all think. I am so worried about him, when he had is liver biopsy it said he was at a 3/4 ?? Not sure what that means.he has a lot of sensitivity in the area of his liver, and to me, has also appears to have fluid buildup. He looks 8 months pregnant to me, and the way his stomach bulges, i can't believe it is just fat. If it were you would you attempt shoulder surgery while on treatment. When he had his other shoulder done a few years ago, it was a living hell....please please ....tell me what you think. I can't stand to see him in all this pain. He also has much fatigue and sleepless nights and joint pain in general, I try to watch how much Advil he takes, because I know that is not good for the liver.

[Advocate1955]

Wow, $25,200.00?
Advocate1955

[WyoSue]

I saw my gastro doc today. BlueCross Federal has added Sovaldi to it's formulary, so it's covered. As near as I can tell, my copay will be 30% of the AWP (average wholesale price). That means I have a copay of $25,200 for 12 wks of Sovaldi. I don't qualify for the Patient Assistance Program because my income is more than 500% of the federal poverty level ($11,490 for a single person, so 500% equals $57,450 per annum). That's OK, I wasn't expecting to live long enough to use my retirement nest egg anyway and it's a lot better than paying the entire $84,000 out-of-pocket. Unfortunately, I still have to wait to start treatment because of other health issues that need to be resolved (broken tooth, digestive problems). But, now knowing that my insurance will cover some of the cost has given me much more hope.

[ppmguy]

        my copay for zoloft is about the same.  sertraline, the generic equivalent is $10 for 90 days.  
barry

[Faithdove]

Dear WyoSue, this is the same thing I had read an article about a few weeks ago for ExpressScripts, as they too were saying they were not going to add it to their formulary so when I checked, I was so excited! Keep checking as it may be added in 2014. I can't imagine that Gilead can get away with keeping the price so high with all the new competition coming soon. Also, call the company as they do have a patient assistance program, but you will still have to pay along with whatever your insurance won't cover. Also see if your doctor can work with them, sometimes that can push things. Maybe others on this thread can give other ideas from their experience. If you have time to wait, I bet the price will be driven down by competition. I know that the pharm companies have to price drugs to make up for all the money spent in the years and years of research, but in this situation, competition will force the price down eventually or people just won't be able to buy it and then basic economics kicks in as well. ...supply verses demand. Let me know what happens with your situation, ok? I will pray that it works out for you.

[WyoSue]

Thanks for answering my question, FaithDove. I did call my insurance company and the person I talked to said Sovaldi is not on their formulary, and she couldn't tell me if it would be covered or not.

[Faithdove]

Dear Barry and Advocate, it appears the Zoloft may have the highest of all the copayments at $80 for 90 day supply. I couldn't get a price for the Interferon yet, but it is covered, and the RBV will be $10 for 90 days if I did the calculations right. I couldn't get an apt with his primary care doc, until Jan 14, so that is not good considering it takes a few weeks for a SSRI to kick in as you mentioned, Barry. I begged the nurse to see if she could get him in sooner if anyone cancels telling her the situation. I can be a real persistent pain in the arse when need be. Must be all my own experience with my own doctors ;p. I want to thank you both for your support. Also I want to wish everyone a happy New Year's Eve and 2014. We will be hunkered down at home tonight, nice and warm as it is freezing here in NJ. I will continue to update as we move into this journey and really appreciate you taking it with me. It is so comforting to know you are all here.