Discussion:
Got prescription for Harvoni... now working on pre-auth
(too old to reply)
Russian
2015-02-01 04:55:17 UTC
Permalink
Hey, for those from the old days who might still check here occasionally...

I did the Peg-interferon + Ribavirn for 48 weeks 2006-2007. I was a responder but did not get SVR - it was back 6 weeks later.

That treatment left me taking synthroid daily plus some other permanent sides, but it did roll the clock back - after the chemo ended, I felt better than I had in years.

That held for awhile but I can feel the Hep C fatigue and occasional what I call "hollow-man" syndrome.

But I had stopped drinking in 2001 and kept to it - never was an alcoholic but my doc said that was the one thing I could do, so I did it.

My liver has deteriorated only very slightly over the last 10 years.

Over the years, my liver doc and I always talked about the latest drug in Phase 1, then Phase 2, then Phase 3... talking about how someday there would be a cure without another year on Riba and interferon.

A few weeks ago, he wrote me a prescription for Harvoni. I was ecstatic.

Then Blue Shield asked for more lab tests - I had already gotten them so the pharmacy sent them.

This week Blue Shield sent me a letter denying my pre-auth because one has to be Stage 3 or 4. Of course I am. They got the ultrasound and diagnosis. And they already had it my medical records from my first course of treatment.

So the pharmacy and the doc are appealing. My doc says not to worry, he's been getting approvals.

Frustrating and a little tense. And like they say, the waiting is the hardest part...
SF
2015-02-02 21:00:08 UTC
Permalink
"Russian" schreef in bericht news:b3546923-4107-473f-85a4-***@googlegroups.com...

Hey, for those from the old days who might still check here occasionally...

<cut>

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thanks for the update and good luck
SF
Thip
2015-02-02 21:08:18 UTC
Permalink
Post by Russian
Hey, for those from the old days who might still check here
occasionally...
I did the Peg-interferon + Ribavirn for 48 weeks 2006-2007. I was a
responder but did not get SVR - it was back 6 weeks later.
That treatment left me taking synthroid daily plus some other permanent
sides, but it did roll the clock back - after the chemo ended, I felt
better than I had in years.
That held for awhile but I can feel the Hep C fatigue and occasional what
I call "hollow-man" syndrome.
But I had stopped drinking in 2001 and kept to it - never was an alcoholic
but my doc said that was the one thing I could do, so I did it.
My liver has deteriorated only very slightly over the last 10 years.
Over the years, my liver doc and I always talked about the latest drug in
Phase 1, then Phase 2, then Phase 3... talking about how someday there
would be a cure without another year on Riba and interferon.
A few weeks ago, he wrote me a prescription for Harvoni. I was ecstatic.
Then Blue Shield asked for more lab tests - I had already gotten them so
the pharmacy sent them.
This week Blue Shield sent me a letter denying my pre-auth because one has
to be Stage 3 or 4. Of course I am. They got the ultrasound and
diagnosis. And they already had it my medical records from my first course
of treatment.
So the pharmacy and the doc are appealing. My doc says not to worry, he's
been getting approvals.
Frustrating and a little tense. And like they say, the waiting is the hardest part...
That sucks. Keep us posted. I'm probably next on the frustration list and
I don't have a lot of patience these days.
Poindexter Mad Scientist
2015-02-04 23:35:46 UTC
Permalink
Post by Russian
Hey, for those from the old days who might still check here
occasionally...
<snip>
Post by Russian
Frustrating and a little tense. And like they say, the waiting is the hardest part...
That sucks. Keep us posted. I'm probably next on the frustration list and
I don't have a lot of patience these days.
Grats on the Rx, BS on the denial, interesting articles on Gilead in
the last two days:
http://www.nytimes.com/2015/02/04/business/sales-of-sovaldi-new-gilead-h
epatitis-c-drug-soar-to-10-3-billion.html

https://secure.marketwatch.com/story/gilead-to-discount-its-pricey-soval
di-drug-2015-02-04

http://www.bloomberg.com/news/articles/2015-02-03/gilead-hepatitis-c-sal
es-surge-as-drugmaker-announces-dividend
--
Poindexter M.S.
Russian
2015-02-14 05:57:16 UTC
Permalink
I forget if we are top-posters or bottom-posters here :) Remember all the flame-wars over that (not here but on the usenet) ?

Anyway, good links.. Thanks.
Post by Poindexter Mad Scientist
Grats on the Rx, BS on the denial, interesting articles on Gilead in
http://www.nytimes.com/2015/02/04/business/sales-of-sovaldi-new-gilead-h
epatitis-c-drug-soar-to-10-3-billion.html
https://secure.marketwatch.com/story/gilead-to-discount-its-pricey-soval
di-drug-2015-02-04
http://www.bloomberg.com/news/articles/2015-02-03/gilead-hepatitis-c-sal
es-surge-as-drugmaker-announces-dividend
--
Poindexter M.S.
Poindexter Mad Scientist
2015-02-16 05:01:57 UTC
Permalink
Post by Russian
I forget if we are top-posters or bottom-posters here :) Remember all the
flame-wars over that (not here but on the usenet) ?
Oh yeah, I may have even taken part in one or two, since I always
considered bottom posting the more logical of the two.

Any more I just figger it's the app you use and the habits you keep
more then anything else. <g>
Post by Russian
Anyway, good links.. Thanks.
You're welcome, glad I brought something interesting to the
conversation.
Post by Russian
Post by Poindexter Mad Scientist
Grats on the Rx, BS on the denial, interesting articles on Gilead in
http://www.nytimes.com/2015/02/04/business/sales-of-sovaldi-new-gilead-h
epatitis-c-drug-soar-to-10-3-billion.html
https://secure.marketwatch.com/story/gilead-to-discount-its-pricey-soval
di-drug-2015-02-04
http://www.bloomberg.com/news/articles/2015-02-03/gilead-hepatitis-c-sal
es-surge-as-drugmaker-announces-dividend
--
Poindexter M.S.
--
Poindexter M.S.
Russian
2015-02-14 06:08:18 UTC
Permalink
Post by Thip
That sucks. Keep us posted. I'm probably next on the frustration list and
I don't have a lot of patience these days.
So it turns out my doctor sent the pharmacy 2013 labs, not the ones from November 2014. It took 2 weeks to get those labs successfully sent to the pharmacy (yes we faxed it, no they didn't, yes we did, we never got them, etc.).

So now the pharmacy has put in an appeal of the denial.

Apparently, I'm between stage 2 and stage 3. Yet my doctor says I'm beyond fibrosis and borderline cirrhosis.

I feel like, so if you take care of yourself and stop drinking, like I did in 1999, you don't get the drug because you're not sick enough. Wha?

Reading Poindexter's links, I see that the insurance companies are negotiating with the pharma companies to exclusively authorize one treatment only.

Since Blue Shield of California hasn't made a deal, I guess they're just stalling...
Thip
2015-02-14 19:42:32 UTC
Permalink
Top post, bottom post, who gives a rip any more? There are sooooo many
things gone wrong with Usenet (Google) that where you post doesn't matter as
much as what you post. Anywho--

I think my doctor is sending me off for transplant eval/qualification simply
because he knows I can get the drugs that way. Back in the day when I
really cared I was level 4/grade 4, so who knows what I am now?

So they want to authorize one treatment and you have to be sick enough to
qualify. That means the insurance companies will end up paying for
transplants instead. That just makes all kinds of sense to me, or maybe
they're hoping we'll go ahead and croak before we cost them too much.
Post by Russian
Post by Thip
That sucks. Keep us posted. I'm probably next on the frustration list and
I don't have a lot of patience these days.
So it turns out my doctor sent the pharmacy 2013 labs, not the ones from
November 2014. It took 2 weeks to get those labs successfully sent to the
pharmacy (yes we faxed it, no they didn't, yes we did, we never got them,
etc.).
So now the pharmacy has put in an appeal of the denial.
Apparently, I'm between stage 2 and stage 3. Yet my doctor says I'm
beyond fibrosis and borderline cirrhosis.
I feel like, so if you take care of yourself and stop drinking, like I did
in 1999, you don't get the drug because you're not sick enough. Wha?
Reading Poindexter's links, I see that the insurance companies are
negotiating with the pharma companies to exclusively authorize one
treatment only.
Since Blue Shield of California hasn't made a deal, I guess they're just stalling...
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