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The Latest Hepatitis C Treatment Recommendations: Who Decides Your Future?

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6 Comments

Lucinda K. Porter, RN

Hi Krissy, It is so important to know our docs are doing the right thing. Assuming there is no cirrhosis, your doc is doing the right thing. 8 weeks is all the treatment that is recommended. I am sorry about the level of communication - it sounds hard. You have a good shot at an SVR - let us know the outcome.

April 1, 2015

krissy

Hi I have been on 8 weeks of Harvoni per guidelines written by UHC, treatment naive,current viral load less than 6 million. First, the Dr. has seen me since 1991,and I am not sure as a GI he is informed enough. When it was "my decision" on treatment and treatment type,they originally told me wrong info on plan exclusions. I just tested HCV not detected at 4 and 6 weeks, I applied to Gilead for patient assistance because "I think there is a supply limit, or a prior authorization for another 12 weeks. He is refusing to do twelve weeks says , he is following the rules and insurance company said, and not what I am saying. I do not think in the future they will cover me as they are issuing medical policy statments, to "prioritize" hep c, ie . not pay for treatment. If I relapse who covers me? not him. When it was my decision for treatment early on he cut me off and said it is his decision, trials are limited, where is the data for treatment when you have multiple chronic conditions and your Dr. doesn't care?

April 1, 2015

Lucinda K. Porter, RN

Hi, Each state program is different, and I am not up on the requirements. However, in general, platelets above 90 K are considered safe to treat interferon, so unless you have another reason that proves you are interferon-intolerant (such as an autoimmune condition, severe depression, etc), you may be temporarily out of luck. Suggestions: 1) Join the Hep Forums (http://forums.hepmag.com) and ask how people have gotten their approvals through (lots of people on S+O on the Hep Forum 2) Wait until Oct 10 for new drugs - that is less than 2 months away 3) Contact NVHR and ask them if they have suggestions http://nvhr.org/ 4) Contact the drug companies for help 5) Use a patient advocacy program Most important - don't let discouragement stop you. You fought hep C this long, you can fight the insurance company.

August 20, 2014

trapper

Hi Lucinda. I have type 1,f-3. My dr put in for osy/sov treatment 3 times. 1st denial they said drugs were for patients with f-3 or worst liver fibrosis. Got a liver biopsy showed f-3 fib. Re-submitted. UHC said I didn't qualify because my platelet count was above 70k and there was another medication that I need to try first. Third denial they said my plan rules do not allow us to approve this for your condition. I have UHC Medicaid. Is f-3 fib. not enough to qualify. Here are my stats. Type 1, 23076258 HCV quantitation, 122 alt, 75 ast, 4.1 albumin, .87 alkaline phos, .6 bilirubin, 1.14 inr, 114 platelets, 15.9 hgb, 46 htc, 7 wbc, anc 3.4, f-3 liver biopsy, 2:4 index 86 fibrospect II, 24 ammonia. does this qual. for osy/sov thanks trapper

August 20, 2014

Lucinda K. Porter, RN

This is heartbreaking. I hope you can find a moment of strength to prevail, or for an advocate to help you. I recommend you join the Hep Forums (http://forums.hepmag.com) - there is lots of wisdom there.

August 18, 2014

butch / Texas

Hey Lucinda we have talked in passed. I was stage 2 in 2005 and since much worse. Went through losing insurance then years later getting the poverty insurance "Medicaid". Now only get a P.C. doctor and every time I try to get any other type of doctor I am told they can't see me because I am in too much pain. Pain doctors go berserk that a guy with hep C is asking for "Drugs" for pain and make me leave. I live in bed with no way out and unable to fight for myself anymore. Waited 25 years for this new drug and looks like I will lose the race at the finish line. Just thought you should know there are other reasons for getting denied. Thank you for being there and for all you do. Take care

August 18, 2014

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