Gilead will help if you have been denied

[Sarah1949]

If your insurance company has denied you twice for Harvoni then Gilead, the makers of Harvoni, will help you.

Just go to their support site here -
http://www.mysupportpath.com/

I've noticed people referring to other sites, but the most simple route is a direct one. Just ask Gilead for help.

Good luck!

[Emily_MHManager]

Hi everyone -

We are closing this thread. Anyone can choose which place to start, and now they know they have options. That's what matters, right? No need to argue.

Have a great day,

Emily

[AWorriedMom]

Your definition of warehousing is the same as mine. I work for the hepatitis C patient. I founded Hepatitis C Association in 2000 after working for another hep C non-profit for five years. We have been involved in advocacy for hepatitis C since 1995. Our main mission is to provide accurate information for patients and clinicians who work with them. Our most successsful program was the development of a CEU accredited educational program for clinicians who work in substance abuse clinics. It was funded by HHS (Substance Abuse and Mental Health Services Administration). It ran for 10 years. Help4Hep is one of the programs our non-profit is involved in along with Hepatitis C Connection, Health Pro (used to be Alert Health), and Project Inform. Alan Franciscus (HCV Advocate) is also involved by supplying us with written materials to send to patients. This program was begun with funds from Vertex as they saw a need for a place where patients could go for resources. After the first year, a number of other pharmaceutical companies started funding the program.

Dee, I am interested in your comment that you have seen Gilead help when a person didn't have a doctor. I didn't know they were doing that. Can you tell me more about that?

[Dee1956]

Sarah, I am so sorry to hear about what is happening in Oregon, it sounds awful.  To my mind, warehousing was when a new medication was about to come out, they would tell their patients to wait.

What you are talking about doesn't sound like that, it sounds like discrimination.  If I were a patient living in Oregon, I would call Gilead and talk to them, as I have said, they have helped patients with all aspects of tx, not just payment.  When I was helped by Vertex, I was assigned a case working who helped me with everything.  I had ins but they still assisted me and helped me with co pays.

Jimmy, good information. thanks so much

AWM, who do you work for?  

[JimmyMose]

WHEN AND IN WHOM TO INITIATE HCV THERAPY
excerpts only go to link for full details

"Successful hepatitis C treatment results in sustained virologic response (SVR), which is tantamount to virologic cure, and as such, is expected to benefit nearly all chronically infected persons. Evidence clearly supports treatment in all HCV-infected persons, " except...
(of course this is the ideal)

The most immediate and high-impact benefits of SVR will be realized by populations that are at the highest risk for liver-related complications due to progressive liver disease (Metavir F3 or F4) and transplant recipients or those with clinically severe extrahepatic manifestations (Table 1).

Other populations at high risk for liver disease progression (Metavir F2) or with substantial extrahepatic manifestations (Table 1) are also expected to garner appreciable benefits, although the time course for realizing these benefits may be more protracted.

SVR will also remove the risk of further transmission. Treatment of individuals at high risk to transmit HCV to others (Table 2) may yield long-term future benefits from decreased transmission and a potential decrease in HCV disease prevalence.

When therapy is deferred, it is especially important to monitor liver disease in these patients. Among individuals with less-advanced stages of fibrosis, fibrosis progression over time will help determine the urgency of subsequent antiviral therapy. Fibrosis progression varies markedly between individuals based on host, environmental, and viral factors (Table 3).

AASLD/IDSA/IAS–USA. HCV testing and linkage to care. Recommendations for testing, managing, and treating hepatitis C.

http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy

Accessed March, 30, 2015
(be sure to use proper citation including date accessed)
http://www.hcvguidelines.org/news/how-cite-and-permissions

Absolutely, I wish everyone with HCV could get treated within the next couple of months but that is not possible now or in the near future.

Personal opinion.
Unfortunately some will have to wait longer than others. The most immediate need NEED it now.  Other populations at high risk for liver disease progression may have to wait for months unless monitoring show increase need.  and Table 2 then 3 to a year.

Those with F0 F1 without increase risk of progression many have to wait a year or more.

I am very sorry for those who have to wait but it is a practical and fair reality as of today

[AWorriedMom]

No one is disputing that. It is the first place we send anyone. When that fails is when you have to have other resources.

[Dee1956]

while i think other sites can be helpful for information; I have seen Gilead help people that didn't have a doctor or know how to even start. I agree with Sarah that Gilead would be the first place I would go if I needed help.

[AWorriedMom]

Thanks Ekkie for your kindness. I truly appreciate that. And, thank YOU for another cool hep C site, Hepceducate.org . It is so nice to see others jumping on board and giving back. Have a nice evening.

[Ekkiemom]

Hi Mom....I'm so grateful you are on this website and a voice for the community we are so lucky.
I just don't understand what the big deal is on this subject...and I repeat it again!  Don't think we should shoot the messenger before we really know all the facts. And if it gets the word out WHO CARES WHERE THEY GO, AS LONG AS THEY GET EDUCATED, AND TREATED (not shouting)
I for one think that advocate sites, including my website are aimed at being a tool to assist others to be advocates for their own
health, and if these places don't help you whenever they can how will they ever get treated. How will we rid this virus in our lifetime.
I'm sorry if this sounds harsh I'm just committed to this!  

Great post Jimmy!
Deb

[AWorriedMom]

Well Sarah, we all know what warehousing of patients means. That is not what you said in your original post. You said, "Are you all able to help people know what to do when the doctors in their area refuse to write prescriptions for treatment, saying that their insurance will not pay for it? That's what happened to me...."  Or is it that you had to wait so long for an appt?

One of our partners just happens to be Hep C Connection in Denver and perhaps they are getting those types of calls, but the majority of counselors are not dealing with that. The main type of warehousing that was going on was doctors waiting to treat until the DAA's were available.

I'm afraid that I am about finished with this topic. You don't seem to want to even try to understand. With each explanation I give you, you ignore and go on to something else. That is not a discussion in my mind. I am sure you are bitter and upset about what happened to you with the doc who wouldn't write your script and I am sorry for that.  It's all water under the bridge now. You got your treatment and you cleared. Enjoy your new hep C status.....hep C free, at last. I am done.

[Sarah1949]

Doctors here in Oregon don't directly refuse to write the prescriptions but rather they tell their patients that their insurance will not pay and then refuse to give you an appointment any time soon. They make you wait months and also will not let you change doctors within a practice. I am surprised you have not heard of this happening. It is often referred to as warehousing patients. At one time you mentioned Caring Ambassadors. They have an office here in Portland and are aware of this practice. This also happens in California with Medicaid patients. I wrote about it once before here but received no help.

[AWorriedMom]

P.S. We do not ask for any identifying information other than a birth date or a first name. It helps us when we get call backs if there is a different counselor. He/she can find the person's back story so the patient doesn't have to go through his whole story again.

[AWorriedMom]

Nice job with this, Jimmy. We always send people to drug manufacturer first. If that works it is easiest for all of us. If not, we work on other ways. We get people at all stages of their journey from they think they have been exposed to people with insurance issues (PAN) is great for that problem, to just plain scared people, to I hate my doc people. So we meet them where they are at and take it from there.

Help4hep is online only to get the patient to our phone line. It is not a site that offers information on hep C or discussion boards or anything like that. It is actually a program of 4 not for profit organizations that came together to provide a free service.

We are proud of our work and the companies that fund us are happy as evidenced by the fact that they repeatedly fund us year after year.

[JimmyMose]

My opinion.  I would use this first.

http://www.mysupportpath.com

Your choice to sign up or just to check your Dr out  Some are great and will spend the time to do it right (with staff help)

I would read these forms
Additional Forms and Resources

Then you can review with Dr and/or office staff to be sure be sure they are as complete as possible first request and if denied appeal. If not have path support help

If approved then get Co-pay help if qualified.  
mySupport Path
Note Co-pay Not valid for patients enrolled in government healthcare prescription drug programs, such as Medicare Part D and Medicaid. Patients in the coverage gap known as the "donut hole" also are not eligible
Depending on Dr and staff, they may provide all the help you need. You provide household income, expenses and etc.

These will offer co-pay help with Medicare and Medicaid and private insurance.  visit site for more details and requirements
https://www.panfoundation.org/hepatitis-c
up to $15,000 limit HCV per year 500% poverty level limit depending on income.

http://www.copays.org/diseases/hepatitis-c#
up to $10,000 limit HCV Per Year 400% poverty level limit depending on income.

If still denied then check possible local non-profit agency help and or online like help-4-hep etc.

Personally I will checkout online sites before registering, providing personal information and or contributing or purchasing anything.
I am concerned when there is no privacy policy and or terms of service info.
For donations to non-profits I use http://www.charitynavigator.org/

Evaluating Health Websites
http://nnlm.gov/outreach/consumer/evalsite.html

https://nccih.nih.gov/health/webresources

[AWorriedMom]

And I must say, that we talk to 100's of patients every month and as far as I know we have never had a report of a doctor refusing to write a script. Doesn't your doctor know about the PAP's? That is a lame excuse and he sounds quite ignorant. We help patients advocate for their own care.

[AWorriedMom]

Yes, we have been able to help some. One of the things we can do is send them to an FQHC (federally qualified health center). As far as Medicaid, we also can help some patients who are insured through Medicaid. The challenge is that it is not consistent across all states. Some states have ridiculous restrictions that are barriers to treatment. We are not miracle workers and we cannot fix everything. But, we don't give up and we succeed more than we fail. And we are proud of the work we do.

[Sarah1949]

Are you all able to help people know what to do when the doctors in their area refuse to write prescriptions for treatment, saying that their insurance will not pay for it? That's what happened to me and now I have a friend it is happening to. I was extremely lucky in that I finally found a NP who wrote the scripts for me. My insurance did indeed pay for my treatment.

Anyway, are you doing anything to help all the people on Medicaid who cannot find a doctor willing to give them a prescription?

Once a person has the prescription they can find funding somewhere and so I see the crux of the problem in obtaining treatment to be getting the prescription. Are you all doing anything to help? I hope so.

[AWorriedMom]

Yes, I believe the goal is to get the word out and for everyone who wants to treat to be able to do just that. Can you imagine a cancer diagnosis and your insurance company telling you that you are not sick enough? RIDICULOUS. There are too many barriers to treatment. I think we all agree on that point. What good is educating the public if we don't offer them the meds they need to get better?

[Ekkiemom]

Just to give my two cents, I really think that any info or website is making people more aware of places to go to get Tx assistance. Including yours

Maybe I am wrong here but isn't the goal to treat everyone! ?
GETTING THE WORD OUT IS PARAMOUNT!!  (Not shouting)

Be well community
D

[AWorriedMom]

Thank you for recognizing that Gilead is a supporter of Help4Hep. They, along with the other pharmas that have DAA's on the market, and drugs in the pipeline, are our biggest funders. After all, it is a win-win situation. We are getting people the means to treat and they are selling their drugs.

[Rbeth]

Hi Sarah,
Gilead has helped many & has not helped many. Sp pharmas find help for many. There are many patient assistance programs. Help4Hep has access to many of those resources. All plus more are clearly up front and above board avenues of finding help. In fact, I'm quite sure Gilead would enforce searching. It's difficult to be angry at the manufacturers of miraculous hep c Tx drugs. It's difficult not to be angry when you can't can't get financial help to treat. After all, the end goal is to get Tx meds & SVR, right? Let's just use every access possible for people to get help & work together, fellow hepper :-)
Blessings to you

[Sarah1949]

I don't know about that. I do know that I've seen people get help directly from Gilead and if they can do that, then why complicate it with a third party. I think it would be more up front and above board to say here is the Gilead site and if they refuse to help you, which I have yet to hear happen, then you can always go somewhere else to explore options. Then, give people your website.

[AWorriedMom]

What you don't know is that Help4Hep has gotten some who were denied by Gilead originally to get  assistance. So going directly may not be the answer for everyone.

[dontworry_behappy1]

I agree.  What happens is people get upset they are denied.  Your doctor still
has to appeal the denial.  This is how lots of medical insurances do business.