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Harvoni not approved
Hi all
Just called express scripts automated line. My request for Harvoni was not approved. Stayed on the line to speak with a representative. The woman reading me the denial could not pronounce any of the med names even had to sound out how to say peg interferon.
Waiting on my denial letter and appeal from my doctors office.
Dang
Lynn
Just called express scripts automated line. My request for Harvoni was not approved. Stayed on the line to speak with a representative. The woman reading me the denial could not pronounce any of the med names even had to sound out how to say peg interferon.
Waiting on my denial letter and appeal from my doctors office.
Dang
Lynn
Hi Dee
Just re reading the posts here and just wanted to let you know I have treated 3 times with interferon based treatments.
First time was interferon monotherapy 3 shots a week as that was all they had to offer then. Non responder.
Second time was riba and interferon I ended up taking 2 weeks off on FMLA and getting Epotin shots as my hemoglobin was dangerously low hence my hesitance to take Ribavirin again. Null responder.
Third time was interferon, Ribavirin and a trial med. Again a null responder viral load actually increased on treatment.
I wanted to treat with telaprevir when it was approved but I had been diagnosed with early cirrhosis 2 years earlier so my doctor would not allow me to treat as the probability of SVR was about 14% and the possibility I could decompensate from treatment.
I would take all the meds out there tomorrow including interferon and Ribavirin if they would give them to me but at this moment there is nothing I am allowed by my insurance to take.
Well I guess I will see if there is anything happening next week
Lynn
Just re reading the posts here and just wanted to let you know I have treated 3 times with interferon based treatments.
First time was interferon monotherapy 3 shots a week as that was all they had to offer then. Non responder.
Second time was riba and interferon I ended up taking 2 weeks off on FMLA and getting Epotin shots as my hemoglobin was dangerously low hence my hesitance to take Ribavirin again. Null responder.
Third time was interferon, Ribavirin and a trial med. Again a null responder viral load actually increased on treatment.
I wanted to treat with telaprevir when it was approved but I had been diagnosed with early cirrhosis 2 years earlier so my doctor would not allow me to treat as the probability of SVR was about 14% and the possibility I could decompensate from treatment.
I would take all the meds out there tomorrow including interferon and Ribavirin if they would give them to me but at this moment there is nothing I am allowed by my insurance to take.
Well I guess I will see if there is anything happening next week
Lynn
Hi Advocate
Best of luck for your husband. It does sound like he should be able to get Harvoni as he did not treat with Sovaldi like I did. Harvoni is in my insurance companies formulary Express Scripts but their pre approval protocol says no if you failed Sovaldi. Hopefully they will be persuaded on appeal.
I sure hope his insurance is not Express Scripts also even though is sounds like he should qualify they seem to be trying to keep patients from getting it and stalling until AbbVie 3D is available because they HOPE it will be less expensive.
Hope it works out for him I will be looking for your posts.
Good luck
Lynn
Best of luck for your husband. It does sound like he should be able to get Harvoni as he did not treat with Sovaldi like I did. Harvoni is in my insurance companies formulary Express Scripts but their pre approval protocol says no if you failed Sovaldi. Hopefully they will be persuaded on appeal.
I sure hope his insurance is not Express Scripts also even though is sounds like he should qualify they seem to be trying to keep patients from getting it and stalling until AbbVie 3D is available because they HOPE it will be less expensive.
Hope it works out for him I will be looking for your posts.
Good luck
Lynn
Hi Everyone
I will definitely check out the video link but just ran across an article about treating with Harvoni after failure with Solvaldi so more info for appeal.
http://medicalxpress.com/news/2014-11-sofosbuvir-ledipasvir-effective-hcv-genotype.html#nRlv
"The fixed-dose combination of sofosbuvir plus ledipasvir was efficacious in a small cohort of patients with HCV GT-1 [who] relapsed after sofosbuvir plus ribavirin therapy, even in the setting of advanced liver disease," the authors write. "Larger studies are needed to confirm these preliminary efficacy results."
So take that Express Scripts!
Yes what ever happens soon somehow I will be treated but this situation with express scripts is just a stupid game on their part. I haven't yet received the official denial letter just another way for them to stall.
Best to everyone I appreciate your support and suggestions it really means a lot to me
Lynn
I will definitely check out the video link but just ran across an article about treating with Harvoni after failure with Solvaldi so more info for appeal.
http://medicalxpress.com/news/2014-11-sofosbuvir-ledipasvir-effective-hcv-genotype.html#nRlv
"The fixed-dose combination of sofosbuvir plus ledipasvir was efficacious in a small cohort of patients with HCV GT-1 [who] relapsed after sofosbuvir plus ribavirin therapy, even in the setting of advanced liver disease," the authors write. "Larger studies are needed to confirm these preliminary efficacy results."
So take that Express Scripts!
Yes what ever happens soon somehow I will be treated but this situation with express scripts is just a stupid game on their part. I haven't yet received the official denial letter just another way for them to stall.
Best to everyone I appreciate your support and suggestions it really means a lot to me
Lynn
Hi lynn I just saw this video by Dr Bacon and it does sound from what he said that the Abbvie V has better results for people with cirrhosis so maybe it will all work out :)
I always try to think that things happen for a reason. We may not always be able to see it at the time. I just happened to come across this video and thought of you.
http://video.healio.com/video/DDW-Bruce-Bacon
On another thought, yeah always another one. While trying to find a real person for you ( prescription approving official) I found that Express Scripts and by way of them Acredo for specialty drugs is a very difficult place to get to talk to anyone. I am sorry I did not realize how hard it was and I apologize for assuming that your insurance hierarchy was like mine.
I looked up the Express Scripts and found hundreds, of people complaining about the service they have received through Acredo while trying to get medications for their children parents, themselves. It sounds like a game.
I was about to switch to BCBS during open season, I don't think I will be now :)
These were mainly people who are on maintenance injections who were missing doses due to stupid mistakes acredo made but I found a person with HCV that could not get his meds on time and was facing a break in his meds. What a nightmare of a way for these poor sick people to have to go. I had to fight with my meds during tx but at least there were people to help.
Take Care
I always try to think that things happen for a reason. We may not always be able to see it at the time. I just happened to come across this video and thought of you.
http://video.healio.com/video/DDW-Bruce-Bacon
On another thought, yeah always another one. While trying to find a real person for you ( prescription approving official) I found that Express Scripts and by way of them Acredo for specialty drugs is a very difficult place to get to talk to anyone. I am sorry I did not realize how hard it was and I apologize for assuming that your insurance hierarchy was like mine.
I looked up the Express Scripts and found hundreds, of people complaining about the service they have received through Acredo while trying to get medications for their children parents, themselves. It sounds like a game.
I was about to switch to BCBS during open season, I don't think I will be now :)
These were mainly people who are on maintenance injections who were missing doses due to stupid mistakes acredo made but I found a person with HCV that could not get his meds on time and was facing a break in his meds. What a nightmare of a way for these poor sick people to have to go. I had to fight with my meds during tx but at least there were people to help.
Take Care
Hi Lynn,
Sorry to hear you are having so much difficulty with the approval process again. As you know, my husband's insurance denied him 3 times for S/O, and his doctor appealed it each time. It was frustrating and discouraging, but hopefully he will be able to begin treatment with Harvoni soon. He has a 6 mo appt with his hepa coming up in 2 weeks (11/26), his insurance company's website says that Harvoni is in their formulary now, and he meets the criteria: previous treatment failures, never treated with sovaldi, and Cirrhosis. We are hoping she will start treatment for him after this next appt.
Best wishes for getting approval or for next med coming out soon.
Advocate1955
Sorry to hear you are having so much difficulty with the approval process again. As you know, my husband's insurance denied him 3 times for S/O, and his doctor appealed it each time. It was frustrating and discouraging, but hopefully he will be able to begin treatment with Harvoni soon. He has a 6 mo appt with his hepa coming up in 2 weeks (11/26), his insurance company's website says that Harvoni is in their formulary now, and he meets the criteria: previous treatment failures, never treated with sovaldi, and Cirrhosis. We are hoping she will start treatment for him after this next appt.
Best wishes for getting approval or for next med coming out soon.
Advocate1955
Hi Dee
I got the 100k annual household income max allowable from 2 different Support Path reps. The second was more helpful and was the one who said they do make exceptions for to high of an income and said she would check for me.
The first rep had me check a link for the application form which asks for proof of income if asking for financial assistance
http://www.mysupportpath.com/~/media/Files/mysupportpath_com/Support_Path_Intake_Form.pdf
But based on what Penn said he should have no trouble qualifying for full coverage for Harvoni from Gilead if he can't get insurance to pick up the tab.
Johnny That is a good thought but I have no idea how I could do that with out losing my job and my house. Better they should expand the trial but by then I guess I would be taking AbbVie and hoping that works.
Worried mom yeah I just got excited when I saw I could qualify and that is exactly a trial I coud use. My doctor said he spoke with Gilead about Sovaldi relapses and Harvoni that they didn't have a lot of data now but they have successfully treated Sovaldi relapse patients with Harvoni so I hope she puts that in an appeal letter.
Express Scripts said on Tuesday they were sending a denial notice to me and my doctor. So far I haven't seen the official notice. Just another way to delay my case...
Best to all
Lynn
I got the 100k annual household income max allowable from 2 different Support Path reps. The second was more helpful and was the one who said they do make exceptions for to high of an income and said she would check for me.
The first rep had me check a link for the application form which asks for proof of income if asking for financial assistance
http://www.mysupportpath.com/~/media/Files/mysupportpath_com/Support_Path_Intake_Form.pdf
But based on what Penn said he should have no trouble qualifying for full coverage for Harvoni from Gilead if he can't get insurance to pick up the tab.
Johnny That is a good thought but I have no idea how I could do that with out losing my job and my house. Better they should expand the trial but by then I guess I would be taking AbbVie and hoping that works.
Worried mom yeah I just got excited when I saw I could qualify and that is exactly a trial I coud use. My doctor said he spoke with Gilead about Sovaldi relapses and Harvoni that they didn't have a lot of data now but they have successfully treated Sovaldi relapse patients with Harvoni so I hope she puts that in an appeal letter.
Express Scripts said on Tuesday they were sending a denial notice to me and my doctor. So far I haven't seen the official notice. Just another way to delay my case...
Best to all
Lynn
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