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Hepatitis C Coverage

Hi all,

I’m planning on going with Florida Blue because they said they do cover Sodalvi. However does anyone know if it’s a regular or specialty drug? If it’s a specialty drug I’ll have to pay 50% of medication which I don’t have the money right now for. Also what medical insurances cover hepatitis c drugs completely? If anyone knows our of experience. Help please I know I have it never went to a specialist to check type. Also will sodalvi cure all types? Thank you. My count was really low it’s relatively new in my system on a regular blood test I got 2.70 don’t know what that means.
3 Responses
683231 tn?1467323017
Sovaldi alone is not a recommended treatment. Also many more treatments have been approved since solvaldi was first approved.

You really need to see your doctor to find out your genotype to know which treatment is best for you. The most common genotype in the US is genotype 1 which can be very effectively treated by several of the new meds.

One of the meds is Harvoni which you may have seen commercials for on TV. It is a combo pill containing Sovaldi and ledipasvir.

A couple of other newer ones are Mavyret and Epclusa.

All hep c medicines are speciality drugs as there are no generic equivalents available. All these drugs are still relatively new. Sovaldi was only approved in December 2013

As far as coverage it varies very much based on your coverage what is in your pharmacy benifits manager formulary. You should give you insurance a call to find out what your specific benefits are.

My employer had Blue Cross Blue Shield with Express scripts as Pharmacy Benefits Manager. My copay was $30/refill non formulary. However, the makers of Harvoni offer a copay coupon so my costs per refill were $5.00.

Epclusa and Mavyret have similar programs. Google Harvoni copay coupon for more information.

I have no idea what your test was with a 2.7 scored do you know the name of the test?

If it was only the antibody test you may not have hep c. People who were exposed to hep c will have positive antibody test results but about 25% of people can beat hepatitis c without any treatment. If you were infected less than 6 months ago your doctor may want to wait to see if you are able to clear the virus.

To know if you are currently infected with the hep c virus you need the HCV RNA by PCR test. This is a test for the virus itself. If this test detects a viral load and it has been more than 6 months since you were exposed then you will need treatment.

My advice is to see your doctor to find out your genotype to know which is the best treatment for you and then take it from there. You will need to see a doctor anyway to get a prescription for Whicker medicine they recommend. Or even if you need treatment if you have not had the HCV RNA test.

Best of luck
18 Comments
So I guess the best thing for me to do is to see a specialist and find out what genotype I have first before looking into medications to fight it. I had an RNA test done by my primary care physician I think but it was less than 6 months I believe. I think I’ll do that first. I thought sodalvi would be the one to get since I hear about it all the time. And I thought it was difficult to get harvoni, is this true? If I can’t afford harvoni is it hard to do the coupon thing, also does your insurance plan have to include harvoni for you to get the coupon. Thankyou for the quick response. Im super young 24 years old, I found out I had it on accident randomly I decided to get a full blood test done one day. Currently I have no symptoms but I want to get rid of it before it develops
I had an RNA test done by my primary care physician I think but it was less than 6 months I believe. I think I will do that first.
---------------------------------------------------------------
What did your RNA test show? If it was the antibodies test that was 2.7 ,this is very low and could mean a "false positive" .
It is only the result of the Pcr/Rna test that can confirm infection.
All I see is HCV ratio  2.70H    <1.0Ratio
Hepatitis  C  AB          Reactive

ANA,SCR,IFA,RFL TITR/PATT ANA Screen, IFA.       Negative.     Negative

Don’t know why this means, I went to primary care doctor and just said to test for everything and this is what it said.
It was an antibody sample I just read it. I’m not sure what it means, I moved to a different state and now am getting my own insurance. I just want to figure out the best way to do this or to find out if I do have it or not. I assumed these tests are accurate
The hepatitis c antibody test if positive only means you may have been exposed to the hepatitis c virus in the past. It does not mean you are currently infected with hepatitis c.

Antibodies are made by our own bodies when your immune system tries to fight off a virus. Unfortunately our immune system is often not successful in fighting off hepatitis c.  

Anyone who was once exposed to the virus will test positive for antibodies to the hep c virus for the rest of their life. Even if they are not currently infected.

About 25% of people exposed to the hep c virus are able to fight off the infection but the remainder of people if they are still infected at six months exposure (as determined when they have the HCV RNA by PCR test that looks for the actual virus in the blood) those people are considered chronically infected and will need treatment to eridicate the hep c virus.

Once you have a positive antibody test your doctors next step would be to order the HCV RNA by PCR test and probably a genotype year along with a liver panel and CBC.

As it stands right now you may not be infected with hep C with only having a positive antibody test.
When you gad the positive hepatitis c antibody test your doctor should have had you take the HCV RNA by PCR test to find out if you are currently infected.

The antibody test is accurate but does not prove current infection. It is only a screening test to see if you have ever been exposed to hepatitis c. It is a much less expensive test to perform than the HCV RNA test.

I had hep c for 37 years. I was cured 4 years ago.

I test “not detected” on the HCV RNA test but if I ever have an antibody test it will show positive because I once had hepatitis c.

It was an antibody sample I just read it. I’m not sure what it means”
—————————————
It means you need the PCR/RNA test now.
As I mentioned, because the AB test was so low my guess it was a false positive, but the PCR will be definitive
Ok thankyou, Hooefully it’s a false positive. I will do that within the next few weeks. I just had no clue there was a process, I thought it was just a test and you receive the medication
Having a positive antibody test if you were exposed in the past and your body was able to fight off the virus is not a false positive. You do have antibodies to hepatitis c. But yes there is a second test to determine if you are currently infected with the virus to know if you will need treatment.

If you are infected you would probably have further testing to see if your liver is still healthy or if you have had the virus long enough to have developed any liver damage.

I had hep c for 37 years before I was finally successfully treated and cured. Unfortunately I was diagnosed with liver cirrhosis after I had been infected for 30 years.

Good luck I hope you test “not detected“ on the HCV RNA test.
Lynn
Reading through the OP ‘s thread I didn’t see anywhere saying there was an exposure.
Possibly I missed it.
Again , with that low of  a S/ co  it most often tends to be a FP
Sandlet
As we have both mentioned to you, whether this is a false positive or you have been exposed with a reactive result on the AB test you need the HCV/RNA test to find out if you  have HCV
Good luck
Hi willbb I am not that familiar with the finer details of antibody testing as I never saw my results of back in 1990 when I donated blood and learned I had hep C. I am sure the test back then was different from current testing.

But as you said either a false positive or a self cured exposure or an actual current active infection can only be determined with the confirmatory HCV RNA test.

Best regards
Hi Lynn

The current testing is not all that different . The studies done show that S/co between 1 and 8 most often show to be a false positive.
The recommendation is as we told the OP to still get tested by PCR even if low as they dont want to miss someone.
Most often when someone has cleared spontaneously it is still higher than 8.
Having said that as time goes on yes, it may get lower.
Somewhat confusing.
Just that you may mention to posters that if very low,it very well may be a FP.
Best to you,keep up the excellent help you offer.
Sorry ,meant to add this

Anti-HCV signal to cut-off ratio (S/CO)
Among 332 participants with S/CO >8.0 (range 8.16–49): HCV RNA status could be
ascertained for 288 (87%) and among these 217 (75%) were positive indicating current
infection; overall RIBA was positive for 311 (93.7%), indeterminate for 2.4%, and negative
for 3.9%. In contrast, among 147 with S/CO ≥ 1.0 but <8 (range 1.0–7.9): HCV RNA status
could be ascertained for 136 (93%) and was positive indicating current infection for one
(0.7%); overall RIBA was positive for 8.3%, 28.3% indeterminate for 28.3%, and ne

I cut some of that off

Said:
negative for 64.4%
Yeah I never saw my result from the blood bank back then.  They just said I tested positive and I should see my doctor.  I was diagnosed just in the basis of a positive antibody test and elevated liver enzymes. Back then the antibody test was new and there was no HCV RNA test at the time.

My first treatment with intron alpha mono therapy three shots a week with no other med I think in maybe 1985 there was no viral load testing to evaluate efficacy. The only way they knew it wasn’t working for me was my liver enzymes remained elevated.

Sounds like the dark ages now. I guess it kinda was.

Thanks for the additional information.
Yeah,I remember those days
The old Non- A non B deal
Inf.  only with about a 20 % chance of SVR.Eek!
Things sure have come a long ways huh.
Messed up the year I meant to say about 1995

Yeah huge changes since 2014 I sure which they would have had these meds before I was diagnosed with cirrhosis but at least I lived to be cured.
683231 tn?1467323017
Sovaldi required the use of ribavirin along with it it is not a solo treatment. Really I haven’t heard much about anyone being prescribed Sovaldi ribavirin since Harvoni was approved.

The copay coupon is used after your insurance approved your prescription tooff set your copay costs. There are restrictions to qualify for the coupon I suggest you look up Harvoni copay coupon or Epclusa copay coupon. I believe the restriction has to do with Medicare or something. But in general the coupon is no problem to get all you have to do is ask on the site once you are approved by your insurance. Check out Harvoni copay coupon for the details.

From the Harvoni copay coupon site:

“Eligible patients may pay no more than $5 per co-pay for HARVONI

We believe that cost should not be a barrier to receiving treatment. That’s why the makers of HARVONI offer a co-pay coupon. If you are eligible, you may pay no more than $5 per co-pay. Need a replacement coupon?

Please note the following:

You are not eligible if you are enrolled in a government healthcare prescription drug program such as Medicare Part D or Medicaid. This includes when you are in the Medicare Part D coverage gap known as the "donut hole."
The HARVONI Co-pay Coupon Program will cover the out-of-pocket costs of your HARVONI prescriptions up to a maximum of 25% of the catalog price of a 12-week regimen of HARVONI. See Terms and Conditions below.

Check your eligibility

*Are you a current resident of the 50 states, District of Columbia, Puerto Rico, Guam, or the Virgin Islands?

Yes No
*Are your prescriptions paid for in part or in full by any state- or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE? Please note that Medicare Part D enrollees, while in the prescription drug coverage gap (the “donut hole”), are not eligible for the co-pay coupon.

Yes No
*If you begin receiving prescription benefits from such state- or federally funded programs at any time, you will no longer be eligible to use the co-pay coupon. Do you acknowledge your agreement with this statement?

Yes No

For financial or insurance assistance, call 1-855-769-7284.


Co-pay Coupon Terms and Conditions

The HARVONI Co-pay Coupon Program will cover the out-of-pocket costs of your HARVONI prescriptions after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-week regimen of HARVONI. The offer is valid for 6 months from the time of first redemption.
The HARVONI co-pay coupon (“Coupon”) can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S., Puerto Rico, or U.S. territories. You must be at least 18 years old to use the Coupon for yourself or a minor.
The Coupon is limited to one per person and is not transferable. No substitutions are permitted. The Coupon is only available with a valid prescription. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)'s patient assistance programs.
The Coupon is not insurance and is not intended to substitute for insurance.
The Coupon is valid only for patients with commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:
in whole or part by Medicare, Medicaid or a Medicare Part D plan, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan (“Healthcare Reform”), or any other state- or federally funded healthcare benefit program (collectively, “Government Programs”); or
by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs.
Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not eligible for the Coupon. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the Coupon. Void where prohibited by law, taxed, or restricted.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipt of Coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Coupon, as required.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the date the prescription is filled, the number of pills or product dispensed by the pharmacists, and the amount of your co-pay that will be paid for by using the Coupon. For more information, please see the Gilead Privacy Policy at www.gilead.com.
Gilead reserves the right to terminate, rescind, revoke, or modify the Coupon at any time without notice.
HARVONI is a prescription medicine used to treat adults with chronic (lasting a long time) hepatitis C (Hep C) genotype (GT) 1, 4, 5 or 6 infection with or without cirrhosis (compensated). In those with GT 1 and advanced cirrhosis (decompensated) or with GT 1 or 4 with or without cirrhosis (compensated) who have had a liver transplant, HARVONI is used with ribavirin.”

Harvoni along with Epclusa and Mavyret and a few other newer highly effective hep c medicines are available through many insurances the only way to know about your insurance coverage is either ask over the phone or go to your insurance information online and see what is in their approved formulary.

I think you should see your doctor and let them determine what testing needs to be done based on your history.
Likely that would be the HCV RNA if you are 6 months post exposure followed by a genome test along with CBC and liver panel..

Your doctor should help you through the process of getting treatment medicines.
1 Comments
Thankyou I am getting my own insurance being that my company doesn’t provide insurance. I will definitely look at harvoni coupon if I need it. I am going to get one more test done to see if the number changes that I listed above. All I saw was reactive and I assumed I had it but I haven’t gone to a specialist yet.
Avatar universal
Hi everyone , I contacted the manufacturer of Solvaldi in Bangladesh. I ordered it directly for under $2,000 US.  I used my U.S. prescription. The risk is from customs in the U.S. your shipment may get red flagged. I had zero issues. The transaction was little strange overall but its the same stuff and worked.  I used Beacon Pharma ,just send them an email and be patient.  The problem I had is the first drug did not work. So insurance won't pay for the 2nd try. If you go the insurance route and it does not work your in a bad situation. Try my way and be patient. Once your cleared its all really fast.
1 Comments
I failed three treatments with the old interferon based treatments.

When the new meds were first approved I treated for 12 weeks with Sovaldi and Olysio but relapsed. A few months later Harvoni was approved my insurance approved a 24 week treatment with Harvoni and ribavirin.

I am now 3.5 years cured.

Sorry about your experience with your insurance. Did you appeal your denial? I was initially denied also but they had incorrect information.

But anyway congrats on your cure!

My suggestion is to appeal to your insurance provider and if denied appeal to your states insurance commission. Make your insurance do its job.
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