kind of down now

[truredhead]

I just got a call from my doctors nurse because I called her back about a blood test for the Q80 I took for Olysio a month ago. Well she told me that my Humana insurance turned down the Olysio but the doctor said we will get the Solvaldi though. She said she did not know if it was the blood test or because of the cost of Olysio. I do not know what to think, she set an appt up for Aug.13th and it had been for the end of Sept. so I guess I will start around the August appt. I read so many are relapsing and I feel so bad for them. I just do not know whether to be happy about starting tx soon or if it is a waste of time? I know none of you know either but everyone on here is always so helpful, and that is one reason I always try to run things by you all, I usually learn something when I do. Thanks.

[sisterevonda]

Thank you both!very imformative...starting the journey,much prayer for all...

[truredhead]

Oh my gosh. I have been on the phone with Humana finding out what they need for approval. They are nice and helpful people too. I have 3 or 4 reasons why I should not take inteferon and that is what they need. They said the doctor left questions unanswered on the form she sent back for requesting the olysio. You really have to stay on these loopholes or it is easy to go right over your head! And I have a new doc that took my regular hep c docs place when she moved out of state. So they are sending her another form and I have to relay to her what they need her to document for appeal. Thanks again and it is so helpful on here for us who have no idea what we are going through on the tx end.

[Pamelajean1]

Awesome news! You go girl!
I went thru 3 appeals and had a Health Wellness advocate working with me so here is what I know about appeals...
Send everything with each appeal as if it were the first time...they don't necessarily go back and look at previous attempts.
The 'letter of necessity' written by your doc is key. Any documents you send in the packet ie, Cosmos study in your case, needs to be referred to in the 'letter of necessity' to insure they actually look and consider it.
The third and final (in my case) appeal is sent to a third party...not the insurance company...and that should work in your favor.
If you can find the 'criteria' Humana has to deem you intolerant for interferon then you and your doc can 'wordsmith' to hopefully comply. I was using words like 'emotionally fragile' towards the end...lol

I know from experience it is imperative that the practitioner or person requesting the PA for the patient have a thorough understanding of the specific criteria the insurance company is looking for to approve. Below is the Criteria needed to be deemed intolerant to treat with interferon...

Intolerance to interferon
Autoimmune hepatitis and other autoimmune disorders
Hypersensitivity to pegylated interferon or any of its components
Decompensated hepatic disease
History of depression, or clinical features consistent with depression
A baseline neutrophil count below 1500/μL, a baseline platelet count below 90,000/μL or baseline hemoglobin below 10 g/dL
History of preexisting cardiac disease

Let me know how it goes....the main thing is not to get discouraged. Remember the end game and know when all avenues are exhausted with your carrier you can then go to Gilead and Janssen. Keep Pounding!  

[truredhead]

You really helped me! I called my supplement Humana and they told me the only reason Olysio was denied was that the doctor did not send in all they asked for. Humana is sending a appeal to me and the doctor and asking for more info. I never would have called them if you did not mention to appeal it then go to olysio site, so maybe it might work out for me! I am so tired of feeling bad and I want to treat but seem like the doctors do not want to mess with all the paperwork, or the nurse I do not know, but she told me that when they do not send everything they ask for they will deny, but we can always find out why. I have bad rashes now and that is why I was afraid of the riba and interferon. So I am staying on it, thank you so much!

[Pamelajean1]

Ok....I'm going to tell you my personal opinion knowing that we all have one and that everyone's should be respected. I wouldn't take interferon and or ribavirin for love nor money.
The facts are that right now today...Sovaldi/Olysio has the highest percent of success AND with the least amount of side effects for GT1. Interferons patent runs out first of 2015 and will be tossed in the trash where it belongs. Ribavirin will follow as soon as there are more options for other GT's.
Your doc is taking the easy way out IMHO. If you can talk him into just writing the script for it...you can walk it thru the approval process with your carrier AND when or if you are completely denied..you will then become eligible to apply to the manufacturer for the drug for free. That's all it takes...exhausting all means to have your insurance pay.
OR you can wait until what we hope will be October when the FDA approves Gilead's new Sovaldi/Ledipasvir one pill tx. Other options are expected to be approved in December and first of 2015.
It all depends on what you are willing to do for yourself....and I totally respect the decision you make. Good Luck and Blessings!

[JimmyMose]

"I just got a call from my doctors nurse because I called her back about a blood test for the Q80 I took for Olysio a month ago. Well she told me that my Humana insurance turned down the Olysio but the doctor said we will get the Solvaldi though."

12 weeks with sovaldi, riba, interferon.is the correct treatment right now for treating GT1 F1-F2 who are INF tolerable

See my comment for details
http://www.medhelp.org/posts/Hepatitis-C/Opinions-pleaseon-type-of-treatment-/show/2237265#post_10744598

and scroll down my next comment.

You really should ask your doctor for his current diagnosis of your Fibrosis Stage and Grade if you haven't already. It could have changed since liver biopsy 5 years ago

Beside biopsies there are other methods your doctor can use to make a current diagnosis

http://www.medhelp.org/posts/Hepatitis-C/Fibrosis-stage-3/show/2236380#post_10745395

All opinions are my non medical opinions except those expressed in the  links to outside sources. The outside sources are responsible for stating the conditions for their recommendations. Their recommendations can be subject to change since my posts and must be verified by going to their links anytime you are using them to ask your doctor questions or make a treatment decision..
  
Wish you luck in getting the right tx in time to archive SVR with minimal side effects and gradual improvement of your liver as much as possible depending on your current circumstances.

[truredhead]

Thks so much for all your replies. I am geno1A and have never treated. I have had a liver biopsy 5 years ago and it was F1-F2 then. I have fairly normal labs most of the time. I just have no energy and so many body aches and pains. I think I got hep c in the early 90's. Either tattoo or drugs probably. My viral load is 17 million. I have had a endoscopy 4 months ago and doc said no varices and tumor marker was 5 standard range. I do not think it is cirrohsis. One doc just wanted the endoscopy money because he said all I could do was 6 months with interferon and come back in 6 months. I know the liver foundation recomends just 12 weeks with sovaldi, riba, interferon.

[Livelife777]

Hi.   I did the Riba/Sov combo without interferon.  Can only tell you that experience.  It was very doable and the sides were manageable.  The only problem was towards the end of treatment because the Riba causes a drop in Hemoglobin.  When that occurs you can feel alot of fatigue.
Nan advised you to perhaps wait for the newer drugs if you were an F1-F2.  Do think that is sound advice.  Should you be in a later stage, you may consider getting started with the meds available now.
There are no guarantees that you will cure this virus.   Alot has to do with "Host Factors" which are predetermined and based on genotype, viral load, prior treater, ect.  I will say that I did clear the virus on the combo I took.  If you can give us some info on your situation as far as cirrh or non, geno, viral load, BMI, treatment naive, we could give you better answers.
Finally there is a cure for this virus.....
Be well
~Kim

[smittlap]

I start S&O TX tomorrow.

Holding my breath to see if it will work in my case. I have a transplant and take meds which complicates things.I have clinical depression as well. I have had Liver Cancer 2X.
Not ideal conditions, but it became unbearable as the doctorS debated whether to take a chance with me since these drugs came about.

I do not accept the things I cannot change very well , so my goal is to search  for spiritual help going forth.

Howard in Hawaii

[nan535]

With that treatment, you must be geno 1a or 1b.  How advanced is your liver damage?  If you are at an early stage (/F1/F2), you may want to talk to your doctor about the possibility of waiting until November for the sovaldi/ledipasvir combo pill which the trials show high cure rates and minimal side effects.
If you are at F3/4, you probably should not wait. There are no guarantees that you will reach SVR, but everyone who starts a Sovaldi based treatment has reported improved lab results, at least stopping further damage to the liver while on treatment.

I wish you the best.

Nan

[flyinlynn]

I was able to get Solvaldi and Olysio because I was a 3 time null responder first mono therapy inteferon 3 times a week then two treatments with interferon and ribavirin for 6 months. Since the I have also developed cirrhosis.

Based on the the treatment regieme recommended by the AASLD guide lines Solvaldi Olysio would be what is recommended for a patient like me. Maybe that is why you could not get that combination because of your individual situation regarding if you have had a prior treatment and if you have cirrhosis.

Also on a side note my doctor never tested me for the Q80K polymorphism as it would not affect my treatment options.

Good luck hope you kick the dragons butt
Lynn

[Dbzc2]

I just finished the sovaldi & olysio and had to go through a special appeal for my treatment.  I think I was approved because I had such a horrific relation to both ribavarin and interferon.  My doc wanted me to do an additional 12 weeks, but I was turned down due to cost.

All I know is that approximately four studies just finished using a variety of drug combinations and time periods, and that recruitment for these treatments begin in October and November of this year.

If I were any of you, I would ask my doc about ALL options.  It seems with each new drug, success rates go up considerably!

Good luck!

Best, dbz

[Buba1962]

Hi,
I am also waiting to start same treatment I was told it was my only available option due to insurance .Cure rate is a lot higher than older options I choose not to take . Hoping I am into txt by August . Looks like we will be on the same road . Keep in touch .

[truredhead]

Can somebody that has treated with the solvaldi, riba and inteferon let me know how it went for them? I wish they would have approved the olysio for me. Probably the medicare.