Anyone getting Sovaldi from VA yet?

[soldieradvocate]

I understand Puget Sound VA Hospital has prioritized a list of who gets Sovaldi first. Does anyone know the criteria. Who gets priority?

[JimmyMose]

Additional  VA info with charts for HCV Treatment Considerations

http://www.hepatitis.va.gov/provider/guidelines/2014hcv/index.asp
Chronic Hepatitis C Virus (HCV) Infection: Treatment Considerations
Recommendations from the Department of Veterans Affairs National Hepatitis C Resource Center Program and the Office of Public Health (March 27, 2014; data last reviewed on March 6, 2014)

The following treatment considerations are based on available medical evidence and represent the opinion of an expert panel of VA HCV clinicians. The purpose of this document is to provide a detailed algorithmic approach to assist in clinical decision-making on HCV treatment considerations based on specific patient characteristics including genotype, treatment history, presence of cirrhosis, and interferon eligibility. The practitioner should interpret these treatment considerations in the clinical context of the individual patient. The content of this document is dynamic and will be revised periodically as new information becomes available.This document is intended to supplement the Veterans Affairs (VA) Pharmacy Benefits Management (PBM) Criteria For Use documents for HCV antivirals. Information in this document may be used to support treatment decisions based on the existing PBM Criteria For Use documents.

Direct pdf link
http://www.hepatitis.va.gov/pdf/2014hcv.pdf

[JimmyMose]

Made error already CORRECTION  greater than 14 drinks greater 7 drinks Greater than 4 drinks per occasion at least once a month  I changed the symbols to text because some times the site coding results in some text not showing.  Hoping we have preview or even limited editing possible sometime in the future.

[JimmyMose]

I'm not a medical professional and it is very hard even to offer my personal non medical opinions and/or suggestions if any without some more specific  information about your hepatitis medical condition.  

How long have you had  HCV (not how you got)?  Biopsy(s) year Stage & Grade and if more year etc  age, AST, ALT, and platelet count, most recent and a couple of past results like a few years back and last year if available other indirect markers like FibroIndex HepaScore Fiber test etc.Direct Markers of Fibrosis  Radiologic Imaging to Estimate Fibrosis. Any other related medical conditions, doctor exams or comments about your current condition..

A lot of info was included just in case you had the info, the desire and time to to post it here or on your personal info, journal etc.
Just a few basic recent blood and liver tests would help
________________________________________________________
You can click my name link to my profile page and click my .My Hepatitis C GT2 - History - Biopsies - Blood Test - Other Conditions Before Treatment Journal which has way more info than needed.

As a VA patient myself I have been able via My Healthy Vet to download my tests information all the way back to the 90's (more limited avail in 90's)

__________________________________________________
For a more detailed info about criteria and test that can be used for  Evaluation and Staging of Liver Fibrosis by professional but free to view by others without registration.
Go to
http://hepatitisc.uw.edu/browse/all/core-concepts
Click module 2.4  Evaluation and Staging of Liver Fibrosis
_______________________________________________________

In another post you mentioned you are GT1. When you talked to your doctor today which type of treatments did you discuss Sovaldi PEG/RBV 12 weeks, Sovaldi & Olysio +-RBV 12 weeks or Sovaldi 7 RBV 24 week?
What Stage and Grade did she think you were currently at?  

Regarding the VA guide
(DISCLAIMER These are excerpts for the currently available as of the date of this comment which is linked above for    
"Sofosbuvir Sovaldi(TM) Criteria for Use March 2014 VA Pharmacy Benefits Management Services, Medical Advisory Panel,
Please verify. I am not responsible for coping errors, extracted partial information out of context, omissions and/or my personal opinions if included)

Interferon-ineligible or intolerant Genotype 1:  interferon-free treatment should only be given to patients in whom interferon intolerance or ineligibility is clearly documented and who have indications for urgent antiviral therapy where the risk of delaying treatment has a high likelihood of adverse outcomes.  Based on modest SVR rates along with the lack of data in cirrhotics and treatment-experienced in Genotype 1, PBM recommends that sofosbuvir/ribavirin not be used. Please refer to Issues for Consideration regarding the role of simeprevir and sofosbuvir in these patients.

The use of simeprevir in combination with sofosbuvir (with or without ribavirin) for 12 weeks in HCV Genotype 1 has only been evaluated in a small on-going Phase II clinical trial (and has not been approved by the FDA). .....  The PBM recognizes the use of this combination as an option in HCV genotype 1 patients with cirrhosis who are interferon-ineligible or intolerant.

Were any other reasons other than serving those with liver disease first mentioned.?

The VA is really serious about this as a reason for exclusion
"Documented ongoing nonadherence to prior medications, medical treatment or failure to complete HCV disease evaluation appointments and procedures or patient is unable to commit to scheduled follow-up/monitoring for the duration of treatment".
(VA usually keeps detailed records to review)

Plus Substance or Alcohol Use this can vary by facility and doctor
"All patients should be evaluated for current alcohol and other substance use, with validated screening instruments such as AUDIT C or CAGE. The presence of current heavy alcohol use (less that 14 drinks per week for men or less than 7 drinks per week for women), binge alcohol use (Less than 4 drinks per occasion at least once a month), or active injection drug use warrants referral to an addiction specialist before treatment initiation.    There are no published data supporting a minimum length of abstinence as an inclusion criterion for HCV anti-viral treatment.  Patients with active substance or alcohol use disorders should be considered for therapy on a case-by-case basis and care should be coordinated with substance use treatment specialists".
(Just wanted to point this out for any Vets reading this and have no idea if it may apply to you)

Depending on your specific situation I may or may not be able to offer more help but if I can I will try.

I wish you the very best in getting the right treatment at the right time before any significant progression or other related condition reduces your chance of achieving SVR and/or developing more serious related conditions post treatment.          

[soldieradvocate]

Met with doctor today. Sounds like she prioritized, serving those with liver disease first, in groups of ten. Looks like it will take about a year before we get in. So discouraging.

[JimmyMose]

I did post the VA interim guidelines priority to an earlier question you asked  

This is just my guess and personal opinion.
It seams that the VA hospitals have started treating in small groups a couple months ago with the most serious immediate treatment need. I was in the least serious condition of the 10 that just started.  Unconfirmed I heard that over the next few months the numbers and frequencies of patients starting treatment hopefully will increase.  An actual patient has to talk to their VA hepatitis C doctor to get better information about when and if they may qualify for the new treatments.  There are too many factors and it's very early treating with these new drugs that it is impossible for provide a definitive answer.  The nitty gritty of who gets treated now can wary from region and/or VA hospital depending on local decisions.      

http://www.medhelp.org/posts/Hepatitis-C/Will-marijuna-use-interfere-with-prescription-of-Sovaldi/show/2111982

[JimmyMose]

YES Just released a couple weeks ago  Sofosbuvir Sovaldi & Simeprevir Olysio

Google search this
Sofosbuvir Sovaldi Criteria for Use March 2014 VA Pharmacy Benefits Management Services, Medical Advisory Panel,

or
the direct MS Word doc download link (You will need MS Word doc software, MS word reader, LibreOffice writer or a MS Word reader browser plugin  

http://www.pbm.va.gov/PBM/clinicalguidance/criteriaforuse/Sofosbuvir_Criteria_for_Use.doc

Another option use Google cache to open in browser
http://webcache.googleusercontent.com/search?q=cache:V8BQQUmCKK8J:www.pbm.va.gov/PBM/clinicalguidance/criteriaforuse/Sofosbuvir_Criteria_for_Use.doc+&cd=1&hl=en&ct=clnk&gl=us

Google search
Simeprevir Olysio Criteria for Use March 2014 VA Pharmacy Benefits Management Services, Medical Advisory Panel,

http://www.pbm.va.gov/PBM/clinicalguidance/criteriaforuse/Simeprevir_Criteria_for_Use.doc

Another option use Google cache to open in browser
http://webcache.googleusercontent.com/search?q=cache:9zGKRIGeMNAJ:www.pbm.va.gov/PBM/clinicalguidance/criteriaforuse/Simeprevir_Criteria_for_Use.doc+&cd=1&hl=en&ct=clnk&gl=us

Tip when you see the google search results look at the second line under the link go from left to right until you see the first blue triangle icon pointing down (if there is one) LEFT click on it and select cached not the last triangle.

I just started tx GT2 cirrhosis Class A well compensated.on April 2nd SOV/RVB 12 weeks all good so far.

Because of the way it's formated and with tables and the > symbols it's and the way comments are formatted when posting it can cause some text lines to disappear.  

So as soon as I or someone else can  summarize it and properly post it you will have to use of the the methods to view a MS word doc file or download it.