Anthem Blue Cross has Harvoni

[tobila]

Prior Authorization form here. Similar to Solvaldi.

http://www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf?na=pharminfo

[hepcandme]

Kaiser lists its formulary in a PDF file on their website but, since it's a PDF, it's not likely to be updated every few days

I am going to phone their 800 number to see what I can find out

[hepcandme]

Called the 800 # at Kaiser and, after voice mail hell for about 20 minutes, finally talked to a Real person who told me that Kaiser added Harvoni to their Formulary Today!

And then proceeded to read to me the standard Kaiser is committed to the quality of care, blah, blah and that a patient's individual doctor would evaluate appropriate treatment options, etc.

Short of sending (Again!) the results of all the Ion studies and the AALD guidelines, what should I be asking my doctor?

In addition to I Want To Begin Treatment with Harvoni Tomorrow!?

[dontworry_behappy1]

This is Kaiser.  Talk loud and and then talk louder.  Funny how that gets their attention and results in action.   Kaiser is supermarket medicine.  When you can't get what you need through customer service.  Stand in the isle and yell.  works every time.

Best to you and getting cured soon

[sunru]

Or quickly go to kaiser member services and write a letter to appeal the GI dept. taking too much time to make a decision on which protocol they want you to be treated on. Since I had a serious rash with previous Peg/rbv this gave them an excuse to delay. Kaiser can delay this process for months if you let them. After they deny your request for whatever reason, then you just appeal their denial. Your appeal will automatically be sent to the State dept of Managed Healthcare for review. In my case the State called kaiser the next day and a kaiser senior exec.called me immediately to offer their support in many ways. I had to do this when my GI dr took months and delayed decide which tx to put me on because in Feb they WERE NOT YET prescribing S&O. I asked kaiser for a second opinion referral to see a hepatologist at ucsf and Dr.Terrault gave her recommends of which tx's would be best given my host factors.

[dontworry_behappy1]

I grew up with Kaiser as my family plan.   Both my parents and many more relatives have died there after long illness.  They do have a complaint line that has to give you an answer within 24 hours.  I found that falling down on the floor and screaming and kicking your feet.... gets you answers to just about all your questions.  And I do mean literally screaming your head off.
For some reason nobody at Kaiser seems to hear you if you don't talk real loud.  Seem you can be put off for the rest of your life if you don't make big deal out getting what you need.  Demand service!  It's what you pay for.

Best to you....glad it worked out for you

[hepcandme]

My doc seemed very defensive when I asked for a referral to Dr. Terrault or when I asked to be seen by a hepatologist for that matter (a year ago)

I was treated "off label" with S/O beginning last March

My doc insists that UCSF is part of the "team" that makes decisions for Kaiser liver patients. It seemed odd for me to learn at a support group meeting from a UCSF staff person that Kaiser and UCSF don't even share data!

How does that make sense? In the same city, same treatments for people with the same or similar stages of liver disease, that they are not sharing data with one another?

Is this true across the board for insurance companies? What do they gain by Not sharing data? And what is lost when they don't?

OK, I am going to start with my regular doc and ask him to approve treatment with Harvoni for 24 weeks. Don't want to start writing appeals or going over his head before he has said definitively no (although he his last response was quite upsetting to me - basically, be patient, people live for years with your condition...)

I know not every doctor has a great bedside manner but I don't think it unprofessional to respond with - We are so excited about this new course of treatment and will do everything possible to see that you are treated straight away

I am 1B, cirrhotic, relapsed after treatment with S/O. Treatment naive before that

Thanks to everyone here for your kind support