I am cheating this week, and posting material written by a Hep Forum member. I asked her if I could publish it because I think it is practical and useful, and I want people who are trying to get hepatitis C treatment to have this information. It was written by Elizabeth Faraone, who advocated for herself, and just started treatment.
"If a doctor tells you that you medical insurance won’t cover the cost of the medicine and he/she refuses to proceed further, tell your doctor that you can walk him/her through a way to get the medicine. If he/she still refuses to help, seek out another doctor. Don’t let the knowledge that you may have to advocate for yourself keep you from getting treatment. You might find a doctor who will make everything easy for you.
Here was the order of events for me:
- I found a new doctor who loves his patients (rich and poor alike) and wanted to help me get treatment. I saw him on Oct.16. I will be his first Harvoni patient. He believes it is a “medical necessity” for all HCV patients to get treatment with the new safe and effective medicines.
- My doctor called in the prescription to my pharmacy.
- My insurance company said they would not cover the medicine.
- I called my insurance company. They told me my doctor was required to submit evidence for a pre-authorization. I called my doctor’s office and told them this. They told me they knew and were working on it.
- I then called Gilead (855-769-7284) and enrolled in their prescription assistance program (Gilead Support Path). They instructed me to download their form and fill it out.
- I downloaded the form, filled everything out that I could (I even filled in the prescription (Harvoni) and dosage). All that was left for me to do was have the doctor complete the form (sign his name and give his ID numbers).
- On Nov. 4, I gave the form to my doctor and he was more than happy to sign it.
- On Nov. 5, my doctor’s office faxed the form (with supporting documentation of my poverty and my lab results that indicated my viral load) to Gilead.
- My doctor was then required to have a “peer to peer” discussion with the insurance company’s medical doctor that denied the request, and the insurance MD once again said, “no.”
- On Nov. 26th, I received a phone call from my doctor’s office telling me that Gilead would be sending me the medicine and had approved 6 months of treatment.