HCV Treatment and Insurance Question

[T246]

I am recently diagnosed with HCV geno 1, F1.
I want to begin Peg, Copeg treatment in early May.  I have the opportunity to change med insurance policies and may be able to save a large amount of money because of lower premiums, but Anthem, BlueCross of Ca will not tell me If  Peg, Co-Peg is covered under the Solutions 2500 plan.  They will not run a cost test If you are not already under that specific plan.  Can anyone confirm that  Anthem Solutions 2500 covers both medications for HCV treatment.?

Help is greatly appreciated.  Treatment can be so expensive and I have no idea how treatment will effect my work.  Insurance companies are certainly not our partners.  How sad.
Thanks in advance for your help and any information.  I just cannot afford to gamble on Anthem, or any insurance company.  None of us can.

[neptune235]

Glad I could be of some help!  Good luck...!  :)

[T246]

Neptune, many thanks.  I used the links you provided, called and asked the question as you suggested and got the answer I needed.

You have been a great help.

Now lets see If we can wack out this virus.
Thanks
T

[T246]

Thanks.  Its hard enough to get them to confirm stuff on the phone, but Neptune is correct, all PPO's cover the same meds.
Thanks
T

[FloridaMouse]

Be VERY careful about switching, especially where Blue Cross is concerned.   I am on m y husband's group insurance plan that changed over to Blue Cross of Florida the first of the year.  I was in week 57 of my 72 week protocol when this happened.  Blue Cross cut off my treatment stating that there was no proof that going 72 weeks increased the eficacy.  This was all despite the fact that my treatment was outlined by Shands at the University of Florida.

It took 3 weeks, assistance from a drug representative to get me drugs (I was not eligible for Peg Assist because my husband made too much), and a lot of fighting and advocating on my behalf by my local GI and Shands to get my treatment reinstated.   My husband was looking at an insurance web site a few days ago and it stated that Blue Cross of CA was one of the worst and had had class action suits filed against them for misrepresentation.

Make sure if Blue Cross of CA tells you something t hat you get it confirmed in writing.

Mouse

[neptune235]

Yes, that is what I am saying.  I *think* that the formulary is the same for all plans.

Remember, these are FDA approved treatments, so there really is no case to be made for denying coverage.

[T246]

Appreciate the info.  Since I want to change policies within Anthem to Solutions 2500 they will just not anwser the specific question.  I will try again though.  Neptune, are you saying that anthem BC of CA covers the meds on all policies.
Thanks
T

[neptune235]

Yes, Anthem BC in California will cover these drugs.  The question to ask is "Are these meds included in the formulary for this plan?"

I poked around bluecrossca.com and found the formulary:

http://w2.anthem.com/pdf/pharmacy/ABC-CA_0708_vers1jk_final_062008.pdf

As has been pointed out, you'll need to use a specific pharmacy by mail order for this stuff.  For Blue Cross California, the pharmacy is Precision Specialy RX Soulutions.  Here is some info about that outfit:

http://www.anthem.com/wps/portal/ca/provider?content_path=provider/f0/s0/t0/pw_a134685.htm&label=Anthem%20Blue%20Cross%20Specialty%20Pharmacy%20Program

I had this insurance last year, and I was completely happy with the service I got from this place.

[T246]

Marc, thanks, I will give it try.  I think Anthem uses a specialty Pharm, but I will call a few and give this a try.
Thanks
T

[nygirl7]

Oh speaking of pharmacies always make sure you have at least one extra shot in the fridge during treatment.  While most times they will do anything to help they don't usually have the meds on hand but they order them for you - if something happens and the syringe jams or you mess up the shot or SOMETHING (in my 72 weeks it happened two times) you need to make sure you have an extra one so you dont have to wait for them to order.

Since most of us did our treatments on Friday night ......... it's impossible to get them to overnight one on a Saturday and it could be catastrophic.

[Marc1955]

I actually posted some advice in a thread below that is relevant to this as well.

First, as I think you understand, it is essential that you get a clear and definitive answer to your question. The folks to turn to to get this answer are . . . your pharmacy. Normally for a treatment like combination therapy you don't use the corner pharmacy. You use a specialized pharmacy that has experience working with these sorts of medications. These are the same sorts of folks who handle cancer treatment, HIV etc. I use a company called Pharmacare, which is now a division of CVS. These pharmacies are on the front line of getting coverage of medications for their patients. They usually have full time staff people who do nothing else but work (and argue with) insurance companies.

The thing to do is identify a pharmacy that you will likely be working with – you could start by asking your doctor's nurse practitioner who he or she recommends. If they are no help, perhaps you can call a Pharmacare branch in CA if there is on. I recall someone on this board saying that a Walgreens branch in a particular part of San Francisco were expert because of their work with HIV patients. Anyway, once you identify a pharmacy, ask to speak to someone in the billing department. Tell them that you are planning to use them for an upcoming treatment and ask them their experience with the specific medical plans you are weighing. They should be able to give you reliable information as to whether the treatment is covered or not.

When you make the inquiry it is important that you refer to the precise names of the medications your doctor will be prescribing. Sometimes insurance companies have formularies that cover one form of a medication and not another.

What you will learn once you start treatment is that your pharmacist is actually a key member of your treatment team. He or she is often your best source of information on a number of issues that arise. Who knew?

Good luck!

[T246]

Thank you for the quick response.  I am working with a major University and its hard to think, but they have not been able to provide any info on this.

I agree with you.  I am going for the treatment and want to kill this HCV.
Thank you for the encouragement and outreach.
T

[nygirl7]

Call the doctors office - they usually have someone who is like the insurance guru and they could probably find out for you.......with all the billing I'm sure they do they'd probably know!

Good luck, I had decided to treat no matter how extensive my damage was too (thinking at first I was a 1 at most) but it turned out that I was stage 3 - so it didn't really matter but I always remember when I thought I was only a 1 thinking "yeah I want to get this before it gets advanced". ah well it went away finally anyway!