Harvoni not approved

[flyinlynn]

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

[Dee1956]

Just thinking about it as I see in your status that you say you could not do incivek or victrellis because you had cirrhosis.  Is it possible that it was because your platelets were too low?  

When getting ready to treat once, I was told that if my platelets were not at 90 I would not be permitted to treat.  I had just been diagnosed with cirrhosis.  Then 3 years later I did the Incivek, Peg, Riba.

Did your insurance state that they would not approve because you had done the Sovaldi?  Just curious, still trying to help, still searching for information.  I have not been able to find much info on people not responding to the Sol/Il but I bet soon there will be people and answers for them as well as you.
I hope so :)

[flyinlynn]

Hi Dee
I am rethinking the Riba with Abbvie 3D combo based on many others comments and possible necessity if I cannot get Harvoni.

I messaged my doctor about a clinical triad here in Seattle for the combo in fact.

As I have said before if I had to and were permitted to I would do the all anti hep c drug olympics heck just prescribe Interferon riba telaprevir sovaldi kill me  or cure me. I just want to be rid of the darned virus.

It just chaps my hide to no end that there is a medication available NOW that the odds are good would cure me but my wonderful prescription drug insurance wont allow me to receive.

Here is something I find quite funny. I got an Email from Express Scripts today asking me what I think about the service I have received so far from my from my prescription drug benefit provider and to fill out a survey. Must restrain myself from what I truly want to say to them but I do intend to reply.

Thanks for your best wishes I hope you are right about getting approved in the end. Unfortunatly I have had no conversations with decision makers only the call screeners for express scripts. I believe their offices are in Minnesota and I am in Wa state and some how I don't think I could get in the building.

Also I do not have much family and no dogs, cats,bird nor even a fish. Just my spouse and my brother who lives in NY. Maybe I can rent a kid from a neighbor lol just kidding. Not sure who I could or should make an appointment with I can't get to anyone.

I work for a large company with 168,000 employees in 9 states and some overseas as well. Most of our HR functions are farmed out to an outside vender located who knows where. When I call after getting through the phone tree I end up on hold for and express scripts call screener.

I do have a good relationship with my doctors office and staff. When I had my appointment one of them said I could be a patient consultant so they know I have done my homework and am highly motivated to be treated.

That all I have for now any suggestions what I should say to the express scripts survey :-)

Lynn

[hepcandme]

So sorry to hear about all this Lynn

If any one deserves to be spared from this insurance labyrinth, it's you

Still, I believe that you will get approved. Document all your conversations with anyone involved with decision making and show them that, not only can you pronounce all the drugs' names but you have a profound knowledge base that includes all the latest trials and recommendations that are currently giving the best results. Bring your big fat binder that you keep all your test results and research. Ask questions

Make appointments to see people in person instead of via email or phone, if possible. Bring your kid, your sister or your puppy to your appointments. This chips away at their seeing you as only a "case"

Empower and be appreciative of your doc who is recommending treatment with Harvoni. I have gotten great results by saying things like "but you are so much more forthcoming than X doctor"  I want to ask what You would do in this situation. It must be very exciting to be on the vanguard of this new era in treatment for HCV!"

We are all there for you Lynne!

If you want to talk, PM me

[can-do-man]

Good post Dee...And very much correct. Thanks

[Dee1956]

Thinking of you. I wanted to mention that many of us with cirrhosis did use interferon, riba and either Incivek or Victrellis.  There was nothing else coming down the pike, this was it.

Many of us got to UND and SVR and are now cured Can-do also has cirrhosis and is cured.

I can understand if you personally can't take Riba but wanted you to know that others have done it. I am only mentioning because there may be others out there reading this and I don't want them to think that Riba is something a person with cirrhosis can't take. I would not want someone to fail because they were afraid to take it.  I learned after my first relapse you have to do what you have to do to get cured.

My platelets started out at 120 and fell to 65.  I never had to take any rescue drugs or get blood transfusions. Hemo started at 14.8 fell to 9.8

That is the biggest problem with tx, we are all different we all react differently.  While I had a hard time on tx there were others who continued to work.  Saying that, I know I could not have worked the first 12 weeks on the Incivek.  
I wish you the best.

[Dee1956]

Hi there, the same thing happened to me.
I tried to mention above that the best thing to do is to call the pharmacy speak to the actual pharmacist (or authority) that denied it.  Customer service is no help.  This is a brand new tx.
I had the same problem where the doctor did not provide all necessary paperwork. I was denied, I called and found out that they did not send my biopsy report.   I don't know why the ins companies can't tell us that but they don't.  I guess it stalls it a bit.

Thanks for sharing that. It does happen.