Great news Beacon! Welcome aboard! So far it has been an easy ride!
Beacon said
Dec 3, 2014
Matt,
Since I'm cirrhotic but tx naïve they approved me 12 weeks as all the guidelines suggest. 24 weeks would
have been better in my opinion because I think ALL cirrhotics should be "treated" the same whether tx exp
or naïve, but I don't make the rules. I think my chances are still good since I seem to have good liver
function and I'm certainly not going to turn this down.....12 weeks....ok I'll take it...:). Got my fingers
crossed for your approval.
Matt Chris said
Dec 3, 2014
Hey Bruce
That is a fantastic speed of approval, BCBS seems to be doing right by our brothers and sisters in Cal.
BTW, Bruce are you doing 12 or 24 weeks?
matt
-- Edited by Matt Chris on Wednesday 3rd of December 2014 05:37:28 AM
Beacon said
Dec 3, 2014
Thanks Justme, Mallani, and Tess. I know nothing in life is guaranteed but I think I've improved my chances quite a bit
by waiting for Harvoni.
Beacon said
Dec 3, 2014
Tig,
Thanks and yeah exciting news for sure and unexpectedly fast. I think that's a good sign for others that B/S of Calif didn't seem to blink an eye on approval. I know lots of people are having approval problems but at least there is some forward "approval" movement. I had a fibrosure lab done last Oct 2013 that said pegged me at .78
which was a high fibrosure score, no biopsy, no fibroscan but from what I can see most insurance carriers
now accept fibro scores including fibrosure (labcorp). Labcorp hasn't posted my latest labs yet and I haven't
talked to my doctor yet so I don't know the latest score but I'm sure it hasn't improved. When I find out I'll
post the score.
justme50 said
Dec 2, 2014
Congratulations Beacon!
You are going to like it!!
mallani said
Dec 2, 2014
Hi Bruce,
Congrats and let's hope you have an easy, successful ride. Cheers.
Tess said
Dec 2, 2014
Beacon wrote:
Hey all, I went to see a new infectious disease doctor on Nov 24. I had a good feeling about her when she brought up Harvoni right away. I went for blood work (viral load, liver panel, Fibrosure) the same day. I got a call from the pharmacy she uses today. They said my insurance HAS APPROVED me for Harvoni. My head is still spinning because this happened so fast! It only took 8 days. Talk about smooth sailing on the approval. The pharmacy that called said the pills have to come by mail order from Caremark CVS and they should call me tomorrow. And to ask them to apply for the manufacturers' co-pay card (coupon) to reduce the co-pay to $5. I was approved for 12 weeks and will get 4 weeks worth at a time. Typical I think. My insurance is Blueshield of California and Caremark CVS is one of their specialty pharmacies. So one more ticket punched and I'll be boarding the Harvoni train soon. I will keep posting my progress and keep everyone in my prayers especially Matt Chris and Isiscat.
Beacon, that is awesome! That's the same specialty pharmacy my BCBS uses. They were fast in my case too. Best of luck!
- Tess
& Oscar
-- Edited by Tess on Wednesday 3rd of December 2014 02:18:04 AM
Tig said
Dec 2, 2014
Hi Beacon,
Outstanding news!! I see you're treatment naive but consider yourself "early" cirrhotic. Have you had a recent biopsy, or fibroscan? I see you mentioned having a recent fibrosure drawn, do you have those results? It's very good to hear about your prompt approval and sure hope the other carriers follow suit. Congratulations!! All aboard....
Tig
Beacon said
Dec 2, 2014
Hey all,
I went to see a new infectious disease doctor on Nov 24. I had a good feeling about her when she brought up
Harvoni right away. I went for blood work (viral load, liver panel, Fibrosure) the same day. I got a call from the
pharmacy she uses today. They said my insurance HAS APPROVED me for Harvoni. My head is still spinning
because this happened so fast! It only took 8 days. Talk about smooth sailing on the approval. The pharmacy
that called said the pills have to come by mail order from Caremark CVS and they should call me tomorrow.
And to ask them to apply for the manufacturers' co-pay card (coupon) to reduce the co-pay to $5. I was approved for
12 weeks and will get 4 weeks worth at a time. Typical I think. My insurance is Blueshield of California and
Caremark CVS is one of their specialty pharmacies. So one more ticket punched and I'll be boarding the Harvoni
train soon. I will keep posting my progress and keep everyone in my prayers especially Matt Chris and Isiscat.
Isiscat2011 said
Nov 29, 2014
Beacon wrote:
Some of the roadblocks can be seen if you can read a copy of an insurers PA. BCBS twice ask about prior sovaldi based tx regimens, alcohol/substance abuse within the last six months? is the patient cirrhotic? what is the prescribing physicians' specialty? is he/she board certified?
The reality is that much of it is beyond our immediate control. So many factors involved: the insurance company, the company's internal rules and agendas, the specific policy, the physician, the physican's staff, the PBM's policies and agendas, the PBM caseworker, and on and on.
I know people find comfort in thinking they are masters of their own fate--and the timeline of their tx-- but the reality is more complicated. None of the roadblocks you mentioned had any bearing on the delays in my case.
Beacon said
Nov 29, 2014
Some of the roadblocks can be seen if you can read a copy of an insurers PA. BCBS twice ask about prior sovaldi based tx regimens, alcohol/substance abuse within the last six months? is the patient cirrhotic? what is the prescribing physicians' specialty? is he/she board certified?
Isiscat2011 said
Nov 29, 2014
Beacon wrote:
Isis so they give the wrong fax and then put a 72 hour time limit on receiving your labs. Why the short time frame...oh I know ....they figure
you'll get frustrated and go away after repeat denials. Denied...denied..denied again...it's like you're playing a game and they are
just swatting you away. It would have been better to have done the labs and then the PA.
The sad thing is that many people who are in urgent need, and who are eligible for immediate tx, will give up because they feel mentally, physically, and spiritually defeated. One day all HCV patients will be able to walk into a doctor's office, receive an Rx for tx, and have it filled without having to battle for it. Unfortunately, we are not there yet.
You are right about the lab work. Perhaps this will serve as a lesson to others: Make sure your doc orders new labs (including a VL check) if yours are > 6 weeks old! Many payers are enacting hoops such as these that we will have to jump through and payers are making up new rules as they go. We live and learn.
P.S. I believe the 72 hours was from the date/time my doc filed the appeal. She did that right away--before I even saw the denial letter--she may have even done it telephonically.
-- Edited by Isiscat2011 on Saturday 29th of November 2014 05:16:46 PM
-- Edited by Isiscat2011 on Saturday 29th of November 2014 05:19:28 PM
Beacon said
Nov 29, 2014
Isis so they give the wrong fax and then put a 72 hour time limit on receiving your labs. Why the short time frame...oh I know ....they figure
you'll get frustrated and go away after repeat denials. Denied...denied..denied again...it's like you're playing a game and they are
just swatting you away. It would have been better to have done the labs and then the PA.
Isiscat2011 said
Nov 29, 2014
Matt Chris wrote:
Hey Isiscat
That is some strange goings on, subterfuge come to mind but unconscious incompetence is more likely. But then again how convenient for delaying, you would almost think it's all in a grand conspiracy. Fun just thinking about it isn't it.
matt
There is either some gross incompetence going on or it is a deliberate attempt to delay by the insurance company and I tend to believe the latter. This is the second time they have used the excuse that they never received the fax and the PBM says she has proof she sent it.
Patients are certainly having a wide variety of experiences.
Matt Chris said
Nov 29, 2014
Hey Isiscat
That is some strange goings on, subterfuge come to mind but unconscious incompetence is more likely. But then again how convenient for delaying, you would almost think it's all in a grand conspiracy. Fun just thinking about it isn't it.
matt
Fireman Rob said
Nov 28, 2014
It's truly amazing how such a preconceived, simple process can get so messed up for sure. knowing there's a cure and waiting around, watching incompetence is the worst.
If it makes you feel any better, when I spoke to my doc the other day, he didn't even know SVR 12 was a real benchmark for S/O. Lol- and to make things better he asked how many more weeks I had until I finished therapy. I about died at the lack of understanding on the rx side and the sheer ignorance of a patients status. I'm just glad I knew what I wanted prescribed before he handed me interferon.
Hang in there, Isis. Your time is near according to my crystal ball. Before you know it, you will be posting SVR.
-Rob
Ro said
Nov 28, 2014
Isis,
I so hope it works and you get the answer you want to hear on Tuesday! Glad you are maintaining your good spirits.. Know I wish you the best!
Ro
Isiscat2011 said
Nov 28, 2014
Well, I have been very patient, and wasn't going to bitch and moan about my Harvoni pursuit, but maybe this will help someone else feel better who is having similar problems. Misery loves company!
So, I was already denied once because I didn't submit recent enough labs including a VL count. My doc's office might have anticipated we would need that, but this is all new territory, so no big deal. Btw, my doc is at a liver center in a teaching hospital and they have 2 full time nurses working on Harvoni PA's.
Got the new lab work done and the nurse faxed the paperwork to the PBM last Friday. The PBM faxed it to the insurance company on Monday. I called the insurance company today just to make sure they received the labs and was hoping I might even have an approval today. Instead she told me I was denied again because they had not received the lab work within 72 hours, per their requirement. Second denial !! Boy was I mad. The insurance company blamed the PBM and/or the doc's office for all the delays.
I ended up having a conference call with both the nurse and the PBM caseworker (a supervisor) on the phone. I asked them what the heck is going on because somebody seems to be dropping the ball? They both blamed the insurance company. Apparently, the insurance company has given them both the wrong fax number. (This is true because the wrong fax number was on my 1st denial letter.)
At least the PBM and the nurse are now working together on this and they both promised to follow up and call me by Tuesday. Hopefully, the insurance company (same company as Matt's! but different state) will reopen the PA and accept the lab work without need for a 2nd appeal. UNBELIEVABLE how messed up things can get. When this is over, and I have my Harvoni in hand, I've a mind to ask Donald Trump if he will fire the lot of them. "You're fired!" I haven't been jerked around this hard since I rode that mega roller coaster in Santa Cruz.
Still in good spirits, though, because sooner or later I know I will get my Harvoni. I actually hadn't originally planned to start tx until January, and my liver is hanging in there, so I can live with this delay. It has been 6 weeks since my doc's appointment, btw.
Beacon said
Nov 27, 2014
Matt,
Praying for a breakthrough in appeal process. Something's got to give on the treatment side for you.
Harvoninme said
Nov 27, 2014
Fireman Bob wrote "... We can only do so much until the masses start acting."
The masses are trying. ;0
Isiscat2011 said
Nov 27, 2014
Hi Matt:
I wish you the very best of luck with your appeal. I am perplexed by your doctor's apparent unwillingness to do the doc-to-doc call for you. It doesn't even make sense under the circumstances. Did he refuse to do it or does he still intend to? Has he discussed an alternate plan with you? What the heck is going on with him?
Harvoninme said
Nov 27, 2014
Best of luck with your appeal, Matt.
must ditto this:
NOTE: If your expecting a great amount of help from your medical team (Doctor, nurse, PA people) to file your appeal, you certainly should check first because its more than likely not going to happen. Be your own best advocate and check out the links on how to appeal links on the Dummies guide for appeals thread, it has some useful info.
Matt Chris said
Nov 26, 2014
Hey All
The dosing of Harvoni can be taken anytime according to the prescribing literature, but I agree with taking it at night.
Of course if I ever actually get the darn stuff. Its been 6 weeks since my Doctor appointment and have gotten hardly any traction from either the medical side or the insurance side.
NOTE: If your expecting a great amount of help from your medical team (Doctor, nurse, PA people) to file your appeal, you certainly should check first because its more than likely not going to happen. Be your own best advocate and check out the links on how to appeal links on the Dummies guide for appeals thread, it has some useful info.
I will be sending my 21 page urgent appeal letter/packet to the insurance company today. So hopefully I will see some kind of determination by next week. So on it goes from here nobody knows what twist or turn or where it will flow. Kind of like a river the path of least resistance.
matt
Matt Chris said
Nov 26, 2014
Hey Darkstar / Bob
Great results in only 3 weeks UND, Keep it up and away you fly.
matt
hepCFREEwanab said
Nov 26, 2014
angelseven wrote:
Hi, i was wondering why your preferred to take at night?? thanks i am on day 7
When I asked the pharmacist if taking it a night would be better, she told me the following " Since the medication can make you tired, taking it a night would minimize the SE" and she was right!
pamigo said
Nov 26, 2014
Harvoninme wrote:
"Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!"
Excellent news! Bravo!
Oh yea!
Groupergetter said
Nov 25, 2014
darkstar wrote:
Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!
Hoping and praying it's your turn darkstar. This is a tremendous start. Happy for you
robertsamx said
Nov 25, 2014
GREAT NEWS Darkstar. Congrats!! RC
Mugsy said
Nov 25, 2014
Miss B wrote:
Angelseven & Mugsy,
Congratulations on starting
At that price per pill, it seems you should wear a tiara & white gloves each time you take it.
And, the pills should be gift wrapped, not rattling around in a plastic bottle!
-- Edited by Miss B on Sunday 23rd of November 2014 01:59:53 PM
Miss B you inspired me and I did wear my tiara when I took my first pill. Husband thought I was looney, but I guess he thought that already.
angelseven I took mine at night for a couple reasons. I have a hard time with sleep anyway, so with the possible sx of insomnia, I was hoping I might have an easier time. I have always heard your body repairs itself at night plus it seemed like it would help if my body was at rest. So far so good. I even did some yard work and went to the beach to find pretty rocks and the bending over didn't seem to hurt as much as it has. But night dosing just seems right for me.
angelseven said
Nov 25, 2014
Hi, i was wondering why your preferred to take at night?? thanks i am on day 7
angelseven said
Nov 25, 2014
wow, that is awesome... i don't get a VL test for 4 weeks after start of treatment
Beacon said
Nov 25, 2014
Thanks Justme save me a seat alright. I really feel my new doc is in my corner and I
think if anyone can get me a ticket on the Harvoni train,then it's her. Congrats Fred and Tess.
Beacon said
Nov 25, 2014
Thanks for that information Matt. Sometimes it feels like we walk a tightrope to get to the other side
where we can get treatment, one false move and down you go. :)
Miss B said
Nov 25, 2014
Congratulations, Harvoninme!
Any side effects?
Harvoninme said
Nov 25, 2014
"Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!"
Excellent news! Bravo!
Fireman Rob said
Nov 25, 2014
Nice Darkstar!
Awesome achievment! This made my day. Keep the great news coming.
-Rob
darkstar said
Nov 25, 2014
Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!
Harvoninme said
Nov 25, 2014
It fills me with joy to see all the folks on this train! Grats to you Tess & Fred!
Matt Chris said
Nov 25, 2014
Way to go Tess and Fred
Super congrats on getting your ticket punched, you have overcome the hardest part that is getting on the train. Now that your on the train it will be a smooth easy ride with lots of energy to spare.
matt
Isiscat2011 said
Nov 25, 2014
Alaska Fred wrote:
I received my first months supply of Harvoni and will start on Thanksgiving. So incredibly grateful for another chance to be HepC free! I'll be on the train for 24 wks.and am looking forward to the ride!! Happy Thanksgiving and blessings to all!
A little Harvoni with your turkey, Fred? Way to go!
Matt Chris said
Nov 25, 2014
Hey Beacon
Congrats on seeing your new Doc. sounds like she got it going for you. After your lab work is done the biggest hurtle will be the Prior Authorization from your Health Insurance company.
Make sure you remind or ask your doctor the include a "Letter of Medical Necessity" with the prior authorization application.
matt
LC said
Nov 25, 2014
Isiscat2011 wrote:
Wow, look at that Harvoni! Matt and I should be receiving our own bottles soon. My doc sent my recent lab work/PCR results to Accaria on Friday. They will fax them to the insurance company and I could have an approval this week. The big hold up in my case has been doc's office not submitting all the necessary medical records but looks like things are finally on track. I actually received the unpleasant denial letter that stated the reason for denial was lack of documentation but that should be an easy enough fix. I sure hope Matt's doc has learned how to use a telephone by now.
I'm sure glad to hear this, and can't wait until you and Matt's pills are on their way Isis! You've been so patient, and I know that can't be easy for either of you when you see so many others getting what you need to get better too. My step-niece is an attorney too. I do IT work for her occasionally.
Alaska Fred said
Nov 25, 2014
I received my first months supply of Harvoni and will start on Thanksgiving. So incredibly grateful for another chance to be HepC free! I'll be on the train for 24 wks.and am looking forward to the ride!! Happy Thanksgiving and blessings to all!
Tess said
Nov 25, 2014
Got the call today. Approved for Harvoni! They're overnighting it to me
Good luck everyone!
justme50 said
Nov 25, 2014
It won't be long now and you will be able to join us for the ride!
Beacon said
Nov 25, 2014
I had my first appointment today with my new Infectious Disease doctor. The first thing she brought up was Harvoni.
That was right down my alley. My new doc and I are definitely on the same treatment page. She wants to put me on
the Harvoni train. She asked me when did I want to start treatment...I said ASAP. She said ok let's get this show
on the road. She gave me an order for updated blood work and told me to go get it done as soon as I left her office.
She was quite knowledgeable about hvc and listened carefully to me. I walked in with a big folder filled with paperwork
and she was impressed with me being prepared and organized. Ok step 1 down...next step. I realize nothing is guaranteed
yet but I feel better having gotten the ball rolling. I'll post any updates.
Isiscat2011 said
Nov 24, 2014
Harvoninme wrote:
Isiscat, good luck with your thoughts, predictions and presumptions. I've had 8 years to think this through. You haven't provided any facts or rebuttals that would lead me to a different position.
"Patients will lose. This is how the world works"
I'm more optimistic.
Best of luck on your healing journey!
You have taken my words out of context. Patients will lose more as long as there is no thought given to this panic for Harvoni--at any cost.
I wasn't trying to get you to change the way you feel. We all make our choices; I just get tired of seeing choices cloaked in justifications that defy reality and reason.
Your premise was that asking patients to wait is making pharma rich. In fact, the opposite is true. Your second premise was that it is cheaper to treat non-cirrhotics than cirrhotics. We all know where that line of thinking leads and it isn't a good place.
-- Edited by Isiscat2011 on Monday 24th of November 2014 11:37:14 PM
Harvoninme said
Nov 24, 2014
Isiscat, good luck with your thoughts, predictions and presumptions. I've had 8 years to think this through. You haven't provided any facts or rebuttals that would lead me to a different position.
"Patients will lose. This is how the world works"
I'm more optimistic.
Best of luck on your healing journey!
Isiscat2011 said
Nov 24, 2014
Harvoninme:
I am thinking as opposed to simply reacting.
Supply and demand. If the demand is at a fever pitch Pharma can continue to charge whatever it wants. The willingness to pay any cost (with someone else's money) is not hurting pharma it is helping them.
Insurance companies will continue to delay and slash tx durations. Patients will lose. This is how the world works.
P.S. You can't fight a Revolution from behind a keyboard. But, this isn't really about that, is it?
Great news Beacon! Welcome aboard! So far it has been an easy ride!
Matt,
Since I'm cirrhotic but tx naïve they approved me 12 weeks as all the guidelines suggest. 24 weeks would
have been better in my opinion because I think ALL cirrhotics should be "treated" the same whether tx exp
or naïve, but I don't make the rules. I think my chances are still good since I seem to have good liver
function and I'm certainly not going to turn this down.....12 weeks....ok I'll take it...:). Got my fingers
crossed for your approval.
Hey Bruce
That is a fantastic speed of approval, BCBS seems to be doing right by our brothers and sisters in Cal.
BTW, Bruce are you doing 12 or 24 weeks?
matt
-- Edited by Matt Chris on Wednesday 3rd of December 2014 05:37:28 AM
by waiting for Harvoni.
Tig,
Thanks and yeah exciting news for sure and unexpectedly fast. I think that's a good sign for others that B/S of Calif didn't seem to blink an eye on approval. I know lots of people are having approval problems but at least there is some forward "approval" movement. I had a fibrosure lab done last Oct 2013 that said pegged me at .78
which was a high fibrosure score, no biopsy, no fibroscan but from what I can see most insurance carriers
now accept fibro scores including fibrosure (labcorp). Labcorp hasn't posted my latest labs yet and I haven't
talked to my doctor yet so I don't know the latest score but I'm sure it hasn't improved. When I find out I'll
post the score.
Congratulations Beacon!
You are going to like it!!
Hi Bruce,
Congrats and let's hope you have an easy, successful ride. Cheers.
Beacon, that is awesome! That's the same specialty pharmacy my BCBS uses. They were fast in my case too. Best of luck!
- Tess
& Oscar
-- Edited by Tess on Wednesday 3rd of December 2014 02:18:04 AM
Hi Beacon,
Outstanding news!! I see you're treatment naive but consider yourself "early" cirrhotic. Have you had a recent biopsy, or fibroscan? I see you mentioned having a recent fibrosure drawn, do you have those results? It's very good to hear about your prompt approval and sure hope the other carriers follow suit. Congratulations!! All aboard....
Tig
I went to see a new infectious disease doctor on Nov 24. I had a good feeling about her when she brought up
Harvoni right away. I went for blood work (viral load, liver panel, Fibrosure) the same day. I got a call from the
pharmacy she uses today. They said my insurance HAS APPROVED me for Harvoni. My head is still spinning
because this happened so fast! It only took 8 days. Talk about smooth sailing on the approval. The pharmacy
that called said the pills have to come by mail order from Caremark CVS and they should call me tomorrow.
And to ask them to apply for the manufacturers' co-pay card (coupon) to reduce the co-pay to $5. I was approved for
12 weeks and will get 4 weeks worth at a time. Typical I think. My insurance is Blueshield of California and
Caremark CVS is one of their specialty pharmacies. So one more ticket punched and I'll be boarding the Harvoni
train soon. I will keep posting my progress and keep everyone in my prayers especially Matt Chris and Isiscat.
Some of the roadblocks can be seen if you can read a copy of an insurers PA. BCBS twice ask about prior sovaldi based tx regimens, alcohol/substance abuse within the last six months? is the patient cirrhotic? what is the prescribing physicians' specialty? is he/she board certified?
The sad thing is that many people who are in urgent need, and who are eligible for immediate tx, will give up because they feel mentally, physically, and spiritually defeated. One day all HCV patients will be able to walk into a doctor's office, receive an Rx for tx, and have it filled without having to battle for it. Unfortunately, we are not there yet.
You are right about the lab work. Perhaps this will serve as a lesson to others: Make sure your doc orders new labs (including a VL check) if yours are > 6 weeks old! Many payers are enacting hoops such as these that we will have to jump through and payers are making up new rules as they go. We live and learn.
P.S. I believe the 72 hours was from the date/time my doc filed the appeal. She did that right away--before I even saw the denial letter--she may have even done it telephonically.
-- Edited by Isiscat2011 on Saturday 29th of November 2014 05:16:46 PM
-- Edited by Isiscat2011 on Saturday 29th of November 2014 05:19:28 PM
Isis so they give the wrong fax and then put a 72 hour time limit on receiving your labs. Why the short time frame...oh I know ....they figure
you'll get frustrated and go away after repeat denials. Denied...denied..denied again...it's like you're playing a game and they are
just swatting you away. It would have been better to have done the labs and then the PA.
There is either some gross incompetence going on or it is a deliberate attempt to delay by the insurance company and I tend to believe the latter. This is the second time they have used the excuse that they never received the fax and the PBM says she has proof she sent it.
Patients are certainly having a wide variety of experiences.
Hey Isiscat
That is some strange goings on, subterfuge come to mind but unconscious incompetence is more likely. But then again how convenient for delaying, you would almost think it's all in a grand conspiracy. Fun just thinking about it isn't it.
matt
It's truly amazing how such a preconceived, simple process can get so messed up for sure. knowing there's a cure and waiting around, watching incompetence is the worst.
If it makes you feel any better, when I spoke to my doc the other day, he didn't even know SVR 12 was a real benchmark for S/O. Lol- and to make things better he asked how many more weeks I had until I finished therapy. I about died at the lack of understanding on the rx side and the sheer ignorance of a patients status. I'm just glad I knew what I wanted prescribed before he handed me interferon.
Hang in there, Isis. Your time is near according to my crystal ball. Before you know it, you will be posting SVR.
-Rob
Isis,
I so hope it works and you get the answer you want to hear on Tuesday! Glad you are maintaining your good spirits.. Know I wish you the best!
Ro
Well, I have been very patient, and wasn't going to bitch and moan about my Harvoni pursuit, but maybe this will help someone else feel better who is having similar problems. Misery loves company!
So, I was already denied once because I didn't submit recent enough labs including a VL count. My doc's office might have anticipated we would need that, but this is all new territory, so no big deal. Btw, my doc is at a liver center in a teaching hospital and they have 2 full time nurses working on Harvoni PA's.
Got the new lab work done and the nurse faxed the paperwork to the PBM last Friday. The PBM faxed it to the insurance company on Monday. I called the insurance company today just to make sure they received the labs and was hoping I might even have an approval today. Instead she told me I was denied again because they had not received the lab work within 72 hours, per their requirement. Second denial !! Boy was I mad. The insurance company blamed the PBM and/or the doc's office for all the delays.
I ended up having a conference call with both the nurse and the PBM caseworker (a supervisor) on the phone. I asked them what the heck is going on because somebody seems to be dropping the ball? They both blamed the insurance company.
Apparently, the insurance company has given them both the wrong fax number. (This is true because the wrong fax number was on my 1st denial letter.)
At least the PBM and the nurse are now working together on this and they both promised to follow up and call me by Tuesday. Hopefully, the insurance company (same company as Matt's! but different state) will reopen the PA and accept the lab work without need for a 2nd appeal. UNBELIEVABLE how messed up things can get. When this is over, and I have my Harvoni in hand, I've a mind to ask Donald Trump if he will fire the lot of them. "You're fired!" I haven't been jerked around this hard since I rode that mega roller coaster in Santa Cruz.
Still in good spirits, though, because sooner or later I know I will get my Harvoni. I actually hadn't originally planned to start tx until January, and my liver is hanging in there, so I can live with this delay. It has been 6 weeks since my doc's appointment, btw.
Praying for a breakthrough in appeal process. Something's got to give on the treatment side for you.
Fireman Bob wrote "... We can only do so much until the masses start acting."
The masses are trying. ;0
Hi Matt:
I wish you the very best of luck with your appeal. I am perplexed by your doctor's apparent unwillingness to do the doc-to-doc call for you. It doesn't even make sense under the circumstances. Did he refuse to do it or does he still intend to? Has he discussed an alternate plan with you? What the heck is going on with him?
Best of luck with your appeal, Matt.
must ditto this:
Hey All
The dosing of Harvoni can be taken anytime according to the prescribing literature, but I agree with taking it at night.
Of course if I ever actually get the darn stuff. Its been 6 weeks since my Doctor appointment and have gotten hardly any traction from either the medical side or the insurance side.
NOTE: If your expecting a great amount of help from your medical team (Doctor, nurse, PA people) to file your appeal, you certainly should check first because its more than likely not going to happen. Be your own best advocate and check out the links on how to appeal links on the Dummies guide for appeals thread, it has some useful info.
I will be sending my 21 page urgent appeal letter/packet to the insurance company today. So hopefully I will see some kind of determination by next week. So on it goes from here nobody knows what twist or turn or where it will flow. Kind of like a river the path of least resistance.
matt
Hey Darkstar / Bob
Great results in only 3 weeks UND, Keep it up and away you fly.
matt
When I asked the pharmacist if taking it a night would be better, she told me the following " Since the medication can make you tired, taking it a night would minimize the SE" and she was right!
Oh yea!
Hoping and praying it's your turn darkstar. This is a tremendous start. Happy for you
GREAT NEWS Darkstar. Congrats!! RC
Miss B you inspired me and I did wear my tiara when I took my first pill. Husband thought I was looney, but I guess he thought that already.
angelseven I took mine at night for a couple reasons. I have a hard time with sleep anyway, so with the possible sx of insomnia, I was hoping I might have an easier time. I have always heard your body repairs itself at night plus it seemed like it would help if my body was at rest. So far so good. I even did some yard work and went to the beach to find pretty rocks and the bending over didn't seem to hurt as much as it has. But night dosing just seems right for me.
Hi, i was wondering why your preferred to take at night?? thanks i am on day 7
wow, that is awesome... i don't get a VL test for 4 weeks after start of treatment
Thanks Justme save me a seat alright. I really feel my new doc is in my corner and I
think if anyone can get me a ticket on the Harvoni train,then it's her. Congrats Fred and Tess.
Thanks for that information Matt. Sometimes it feels like we walk a tightrope to get to the other side
where we can get treatment, one false move and down you go. :)
Congratulations, Harvoninme!
Any side effects?
"Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!"
Excellent news! Bravo!
Nice Darkstar!
Awesome achievment! This made my day. Keep the great news coming.
-Rob
Had my labs drawn this AM. First dose was on November 7th. Had to be drawn today because of the holiday. HCV is undetectable!!!
It fills me with joy to see all the folks on this train! Grats to you Tess & Fred!
Way to go Tess and Fred
Super congrats on getting your ticket punched, you have overcome the hardest part that is getting on the train. Now that your on the train it will be a smooth easy ride with lots of energy to spare.
matt
A little Harvoni with your turkey, Fred? Way to go!
Hey Beacon
Congrats on seeing your new Doc. sounds like she got it going for you. After your lab work is done the biggest hurtle will be the Prior Authorization from your Health Insurance company.
Make sure you remind or ask your doctor the include a "Letter of Medical Necessity" with the prior authorization application.
matt
I'm sure glad to hear this, and can't wait until you and Matt's pills are on their way Isis!
You've been so patient, and I know that can't be easy for either of you when you see so many others getting what you need to get better too. My step-niece is an attorney too. I do IT work for her occasionally.
Got the call today. Approved for Harvoni! They're overnighting it to me
Good luck everyone!
It won't be long now and you will be able to join us for the ride!
That was right down my alley. My new doc and I are definitely on the same treatment page. She wants to put me on
the Harvoni train. She asked me when did I want to start treatment...I said ASAP. She said ok let's get this show
on the road. She gave me an order for updated blood work and told me to go get it done as soon as I left her office.
She was quite knowledgeable about hvc and listened carefully to me. I walked in with a big folder filled with paperwork
and she was impressed with me being prepared and organized. Ok step 1 down...next step. I realize nothing is guaranteed
yet but I feel better having gotten the ball rolling. I'll post any updates.
You have taken my words out of context. Patients will lose more as long as there is no thought given to this panic for Harvoni--at any cost.
I wasn't trying to get you to change the way you feel. We all make our choices; I just get tired of seeing choices cloaked in justifications that defy reality and reason.
Your premise was that asking patients to wait is making pharma rich. In fact, the opposite is true. Your second premise was that it is cheaper to treat non-cirrhotics than cirrhotics. We all know where that line of thinking leads and it isn't a good place.
-- Edited by Isiscat2011 on Monday 24th of November 2014 11:37:14 PM
Isiscat, good luck with your thoughts, predictions and presumptions. I've had 8 years to think this through. You haven't provided any facts or rebuttals that would lead me to a different position.
"Patients will lose. This is how the world works"
I'm more optimistic.
Best of luck on your healing journey!
Harvoninme:
I am thinking as opposed to simply reacting.
Supply and demand. If the demand is at a fever pitch Pharma can continue to charge whatever it wants. The willingness to pay any cost (with someone else's money) is not hurting pharma it is helping them.
Insurance companies will continue to delay and slash tx durations. Patients will lose. This is how the world works.
P.S. You can't fight a Revolution from behind a keyboard. But, this isn't really about that, is it?