maintenance

[BJ1fish]

Has anybody had any problems getting insurance to pay for maintenance? My doctor told me since the study came out  that maintenance does not work  insurance companies no longer want to cover it. I have decided to go back on maintenance, but It was recommended I go for SOC. They have no problems getting this approved even though it will be my 6th or 7th time. I just need something to hold me over until I can get Vertex. Being a relapser my chances of  getting in a trail is next to none. I had no problem with the insurance for the last year for maintenance but they things have changed, Just wondering what other people have experienced.  

[Bill1028]

The HALT C study was misleading since the enrollees were rolled into the study when they were determined to be non-responders.  The results of the study would have been different if the enrollees cleared the virus and then reduced the peg dosage.  According to my doc, he has a patient on maintenance for over 9 years at ¼ dose and has dropped a couple stages.  

If rejected by the insurance company, have your doc write a letter as to why it will be cost effective to do maintenance now instead of paying for the alternative.

I'm assuming that you have a lot of damage, if not consider just waiting for a couple years for better odds.

Studies do include relapsers and probably will be increase as the relapser and non-responder populations grow.

[frijole]

Here is what Clinical Care OPtions are saying about maintenance ---

http://www.clinicaloptions.com/Hepatitis/Annual%20Updates/2008%20Annual%20Update/Modules/Lindsay/Pages/Page%205.aspx

In evaluating the use of maintenance therapy, the HALT-C trial failed to show a benefit of long-term, low-dose peginterferon maintenance therapy in patients with advanced fibrosis and clinically compensated liver disease. This finding contrasts somewhat to the results found with COPILOT, where the event-free survival rate was lower in patients with portal hypertension who were treated with peginterferon, but was of borderline statistical significance and may have been due to a difference in the rate of variceal bleeding or a small sample size. Potential study design differences between these 2 trials need to be examined to understand these results, as the detection rate of varices based on the frequency of upper panendoscopy examination and rates and types of prophylactic treatment for variceal bleeding may have varied. Since treatment adherence rates (and subject dropout rates) were also different in the 2 trials, this factor also needs to be taken into consideration. In both trials, extensive analyses are under way to determine whether there are subgroups that may have derived benefit from treatment. These analyses will be important in determining which patients should be treated

Here is the link for the Vertex trial for R/R.  Keep a watch on it because I do think there will be US sites, altho they are not listed yet--  Youare in a predicament and I understand your desire to do maintenance

http://www.clinicaltrials.gov/ct2/show/NCT00703118?term=VERTEX&recr=Open&rank=7

[FrontRangeMom]

Since maintenance doesn't work I'm not sure why you would want to subject yourself to continued dosing.  The results of the study showed that there was no difference in the disease progression rate for those on maintenance vs. those who were not.

I was on maintenance with PEG Intron for about six months then my hepatologist said stop, there was no benefit to me to continue. I'm not sure if my insurance would have continued paying or not.

[Bill1954]

Just a thought; have your doctor write the prescription. Then, if your insurance denies meds, take a copy of the letter of denial and call Commitment to Care or Pegassist. They might be able to provide your meds for free. They do have income parameters, but they might wave them with a letter of denial. Not sure. (Betty at C2C really rocks!)

Call either:

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

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

and see what they say.

Bill