Hello to you also. My Fibrosure score was .78 and therefore the F4 cirrhosis rating. I've got BlueShield through a public agency here in California. I did look at the formulary drug list and Olysio was on the formulary available through their specialty pharmacy and Sovaldi is for now a non-formulary drug for them so if approved it would be a $50 co-pay while Olysio would be $5 co-pay. Now getting approved could be a different story but we'll see when the time comes. It will be interesting to see what price Gilead is going to ask to ask for SOF/LDV.
Matt,
Yeah my ID doctor says he is treating other hcv patients and seems to know something about it although I know it is just "one" of the viruses that he deals with. I think he concentrates more on hiv but I would think with the new DAA's treatment is less complicated and actually my primary physician who diagnosed me is the one who told me to wait for better treatment options while the ID doctor told me I should "treat now" and come back when I'm ready to treat. Right now I've more confidence in my primary regarding treatment because he seems more interested in SVR while the ID is more interested in "treat now". Primary said let's keep an eye on liver function and do an occasional ultrasound. Well treatment is in my future and I won't settle for less than the Gilead combo. I know HVC is to a certain degree and unpredictable drug but God willing I can SVR with the right treatment for my situation.
OldenSlow said
Apr 10, 2014
Hi Bruce and welcome. Sounds like you've got a good handle on your situation and I think you're wise to wait. For what it's worth, as imperfect as the Fibrosure biomarker may be, it is used by some insurors as a qualifier for treatment with the current DAA combo. United Health Care currently requires a Metavir F3 or F4 and accepts a Fibrosure score of .58 or greater in lieu of biopsy. As far as I know, Blue Cross/Blue Shield have yet to update their published guidelines to include the newer DAA's.
Take care and stay in touch.
wayne
Matt Chris said
Apr 10, 2014
Hey Bruce
Thanks for the explanation its make complete sense. I would recommend setting up your appointment with your ID doctor well ahead of time possible sometime after Oct 10 which should be the FDA approval date. My trial doctor was a ID specialist and I also had no real Hepatologist in my area but found one about a hours drive into Wisconsin. With how you described your current condition the ID Doctor should be more than qualified.
Hoping you have a good summer
matt
Beacon said
Apr 10, 2014
Hey Tig,
Thanks to you also for the welcome. I know you've seen my updated post about my liver enzymes actually being out of range. Anyway I think I did what you asked me about the signature line. I'll be around posting, trying to contribute, etc.
Beacon said
Apr 9, 2014
Mallani,
Thanks for the welcome. Actually I've been reading posts here for quite some time but just now joined and I might add that I've gained a lot of knowledge from you and some others here. Supposedly the lower end and the upper end of the Fibrosure is more accurate than in the middle. I thinking that maybe it might not be so bad to have a diagnosis of cirrhosis as far as treatment goes. If my doctor makes a case for me being cirrhotic, it might make for a better argument to the insurance company that I need the new Sovaldi/Ledipasvir treatment in order to stand to best chance at success. I don't know how Blueshield HMO will react to a request for this treatment but I would think a cirrhosis diagnosis couldn't hurt my chances. I could always ask my doctor for a biopsy or Fibroscan later. At any rate as you say it's best for me to wait for Gilead's one pill combo to get approval.
Beacon said
Apr 9, 2014
Up until this dx all ALT/AST levels were normal.
Matt,
Thanks for the reply and sorry for the misunderstanding on my liver panel :). What I was trying to say is that previously my AST/ALT levels were fine looking at my old blood work reports (which I never even thought about before). I changed doctors, he did routine blood work and my AST was 85 and my ALT was 80 so they both were roughly double the top of the reference range. Naturally that sent my PCP on an investigation which led to the HVC diagnosis. I'm with all you guys on waiting for Gilead's Sofosbuvir/Ledipasvir pill in the fall. I've came to the conclusion that's going to be my best chance for SVR. I'm seeing quite few people being approved for the off-label Sovaldi/Simeprevir treatment which seems to be fairly potent but my insurance probably wouldn't approve it and the clinicals aren't comprehensive enough. I'm not even going to ask the ID specialist to try to get that treatment. It's too easy to get in a panic about treatment and not use good judgement. I'll wait for Oct and then talk to the ID doctor.
mallani said
Apr 9, 2014
Hi Bruce,
Welcome from me as well. I agree with Tig, and wouldn't accept a diagnosis of cirrhosis from Fibrosure. I'd want a biopsy or Fibroscan, particularly with normal liver enzymes.
In any case, as a Child-Pugh A, treatment is not dramatically urgent. Sovaldi can cope with a high VL, non-CC IL28B genotypes, and does as well with Afro-Americans. With Geno 1a, I'd wait for Sovaldi/Ledipasvir.
Keep us posted. Cheers.
Tig said
Apr 9, 2014
Hello Bruce,
Welcome to the forum! I'm glad you introduced yourself and appreciate all the extra information you provided straight away! That answers a lot of questions before they were asked. Can I ask you to add them to your signature line? That will keep them in a handy format for all to follow.
I'm also surprised to hear your AST/ALT remain in within normal limits. That's fairly incredible considering you've been diagnosed cirrhotic. I'm not a real fan of using the fibrosure test as the only indicator. In my opinion a biopsy is warranted to confirm it, even a fibroscan would be helpful. I would seek that explanation were I in your position. I agree with Matt that your attitude toward treatment is a good and grounded one. I commend you on doing your homework before jumping in. The new Sovaldi/Ledispavir treatment in the fast track FDA status would be highly recommended in your case and as Matt mentioned, it should be approved in the fall if indicators are correct.
Keep us in the loop, I wish you the best of luck!
Tig
Matt Chris said
Apr 9, 2014
Hello Bruce
Welcome to the forum you have found a good place with caring people than can provide great insight into all things HCV.
I really appreciate your viewpoint on treatment, your mention of being focused more on SVR than making a impetuous decision is good advice for cirrhotics and other patients. But I do understand the anxiety of wanting to treat ASAP, I myself get that feeling from time to time but with Gilead's combo drugs treatment to be very likely be approved in Oct 2014 we now have a real date which we can plan for.
If I have read your post correctly did you say that your ALT & AST are in the normal range?
If so its quite amazing. We look forward to following your progress, before, during and after treatment.
matt
Beacon said
Apr 8, 2014
Hello everyone. I was diagnosed with Hep C in Sept 2013. More tests revealed that I was F4(cirrhosis). Child Pugh score A based on my albumin, bilirubin, INR, etc. Up until this dx all ALT/AST levels were normal. So it was like ok you have hvc and you have progressed to cirrhosis. My insurance is with Blue Shield HMO. With this plan you must choose a medical group and there are no hepatologists in any of the groups. My doctor sent me to an infectious disease(ID) doctor. He diagnosed cirrhosis with a Fibrosure test and said he was advising most of his patients to wait for new tx but he said that I needed to treat now. This was before sofosbuvir received FDA approval. I said to him, "Let me think about it". I think we cirrhotics have moved into a stage that most with hcv are motivated to treat before moving into this stage of the disease. So although I think there is an "urgency to treat" it has to be from the prospective of someone who already has cirrhosis and has to be more cautious about treatment. So as I heard one hepatologist on the internet put it, maybe I need to be more focused on SVR and how to get there rather than just rushing into a tx that stands a good chance of failure and then maybe having the virus mutate and develop resistance to a whole class of inhibitor narrowing my future options. I need to give myself the best shot I can to SVR especially since I am in a "difficult to treat" group-cirrhotic, 62 y.o., GT 1a, high VL, and African-American, probably have Q80k mutation and IL28 non CC (haven't been tested).
Wayne,
Hello to you also. My Fibrosure score was .78 and therefore the F4 cirrhosis rating. I've got BlueShield through a public agency here in California. I did look at the formulary drug list and Olysio was on the formulary available through their specialty pharmacy and Sovaldi is for now a non-formulary drug for them so if approved it would be a $50 co-pay while Olysio would be $5 co-pay. Now getting approved could be a different story but we'll see when the time comes. It will be interesting to see what price Gilead is going to ask to ask for SOF/LDV.
Matt,
Yeah my ID doctor says he is treating other hcv patients and seems to know something about it although I know it is just "one" of the viruses that he deals with. I think he concentrates more on hiv but I would think with the new DAA's treatment is less complicated and actually my primary physician who diagnosed me is the one who told me to wait for better treatment options while the ID doctor told me I should "treat now" and come back when I'm ready to treat. Right now I've more confidence in my primary regarding treatment because he seems more interested in SVR while the ID is more interested in "treat now". Primary said let's keep an eye on liver function and do an occasional ultrasound. Well treatment is in my future and I won't settle for less than the Gilead combo. I know HVC is to a certain degree and unpredictable drug but God willing I can SVR with the right treatment for my situation.
Hi Bruce and welcome. Sounds like you've got a good handle on your situation and I think you're wise to wait. For what it's worth, as imperfect as the Fibrosure biomarker may be, it is used by some insurors as a qualifier for treatment with the current DAA combo. United Health Care currently requires a Metavir F3 or F4 and accepts a Fibrosure score of .58 or greater in lieu of biopsy. As far as I know, Blue Cross/Blue Shield have yet to update their published guidelines to include the newer DAA's.
Take care and stay in touch.
wayne
Hey Bruce
Thanks for the explanation its make complete sense. I would recommend setting up your appointment with your ID doctor well ahead of time possible sometime after Oct 10 which should be the FDA approval date. My trial doctor was a ID specialist and I also had no real Hepatologist in my area but found one about a hours drive into Wisconsin. With how you described your current condition the ID Doctor should be more than qualified.
Hoping you have a good summer
matt
Hey Tig,
Thanks to you also for the welcome. I know you've seen my updated post about my liver enzymes actually being out of range. Anyway I think I did what you asked me about the signature line. I'll be around posting, trying to contribute, etc.
Mallani,
Thanks for the welcome. Actually I've been reading posts here for quite some time but just now joined and I might add that I've gained a lot of knowledge from you and some others here. Supposedly the lower end and the upper end of the Fibrosure is more accurate than in the middle. I thinking that maybe it might not be so bad to have a diagnosis of cirrhosis as far as treatment goes. If my doctor makes a case for me being cirrhotic, it might make for a better argument to the insurance company that I need the new Sovaldi/Ledipasvir treatment in order to stand to best chance at success. I don't know how Blueshield HMO will react to a request for this treatment but I would think a cirrhosis diagnosis couldn't hurt my chances. I could always ask my doctor for a biopsy or Fibroscan later. At any rate as you say it's best for me to wait for Gilead's one pill combo to get approval.
Up until this dx all ALT/AST levels were normal.
Matt,
Thanks for the reply and sorry for the misunderstanding on my liver panel :). What I was trying to say is that previously my AST/ALT levels were fine looking at my old blood work reports (which I never even thought about before). I changed doctors, he did routine blood work and my AST was 85 and my ALT was 80 so they both were roughly double the top of the reference range. Naturally that sent my PCP on an investigation which led to the HVC diagnosis. I'm with all you guys on waiting for Gilead's Sofosbuvir/Ledipasvir pill in the fall. I've came to the conclusion that's going to be my best chance for SVR. I'm seeing quite few people being approved for the off-label Sovaldi/Simeprevir treatment which seems to be fairly potent but my insurance probably wouldn't approve it and the clinicals aren't comprehensive enough. I'm not even going to ask the ID specialist to try to get that treatment. It's too easy to get in a panic about treatment and not use good judgement. I'll wait for Oct and then talk to the ID doctor.
Hi Bruce,
Welcome from me as well. I agree with Tig, and wouldn't accept a diagnosis of cirrhosis from Fibrosure. I'd want a biopsy or Fibroscan, particularly with normal liver enzymes.
In any case, as a Child-Pugh A, treatment is not dramatically urgent. Sovaldi can cope with a high VL, non-CC IL28B genotypes, and does as well with Afro-Americans. With Geno 1a, I'd wait for Sovaldi/Ledipasvir.
Keep us posted. Cheers.
Hello Bruce,
Welcome to the forum! I'm glad you introduced yourself and appreciate all the extra information you provided straight away! That answers a lot of questions before they were asked. Can I ask you to add them to your signature line? That will keep them in a handy format for all to follow.
I'm also surprised to hear your AST/ALT remain in within normal limits. That's fairly incredible considering you've been diagnosed cirrhotic. I'm not a real fan of using the fibrosure test as the only indicator. In my opinion a biopsy is warranted to confirm it, even a fibroscan would be helpful. I would seek that explanation were I in your position. I agree with Matt that your attitude toward treatment is a good and grounded one. I commend you on doing your homework before jumping in. The new Sovaldi/Ledispavir treatment in the fast track FDA status would be highly recommended in your case and as Matt mentioned, it should be approved in the fall if indicators are correct.
Keep us in the loop, I wish you the best of luck!
Tig
Hello Bruce
Welcome to the forum you have found a good place with caring people than can provide great insight into all things HCV.
I really appreciate your viewpoint on treatment, your mention of being focused more on SVR than making a impetuous decision is good advice for cirrhotics and other patients. But I do understand the anxiety of wanting to treat ASAP, I myself get that feeling from time to time but with Gilead's combo drugs treatment to be very likely be approved in Oct 2014 we now have a real date which we can plan for.
If I have read your post correctly did you say that your ALT & AST are in the normal range?
If so its quite amazing. We look forward to following your progress, before, during and after treatment.
matt
Hello everyone. I was diagnosed with Hep C in Sept 2013. More tests revealed that I was F4(cirrhosis). Child Pugh score A based on my albumin, bilirubin, INR, etc. Up until this dx all ALT/AST levels were normal. So it was like ok you have hvc and you have progressed to cirrhosis. My insurance is with Blue Shield HMO. With this plan you must choose a medical group and there are no hepatologists in any of the groups. My doctor sent me to an infectious disease(ID) doctor. He diagnosed cirrhosis with a Fibrosure test and said he was advising most of his patients to wait for new tx but he said that I needed to treat now. This was before sofosbuvir received FDA approval. I said to him, "Let me think about it". I think we cirrhotics have moved into a stage that most with hcv are motivated to treat before moving into this stage of the disease. So although I think there is an "urgency to treat" it has to be from the prospective of someone who already has cirrhosis and has to be more cautious about treatment. So as I heard one hepatologist on the internet put it, maybe I need to be more focused on SVR and how to get there rather than just rushing into a tx that stands a good chance of failure and then maybe having the virus mutate and develop resistance to a whole class of inhibitor narrowing my future options. I need to give myself the best shot I can to SVR especially since I am in a "difficult to treat" group-cirrhotic, 62 y.o., GT 1a, high VL, and African-American, probably have Q80k mutation and IL28 non CC (haven't been tested).