Medicare and Harvoni

[emarmon]

I am close to Medicare age, and have a low viral load, so my doctor says my insurance won't cover Harvoni. Anyone know what Medicare's guidelines are? Do I have to be sympomatic to qualify? It's  pretty frustrating knowing that there is now an easy cure, that I can't get. So I'm hoping the cost will come down soon, or Medicare will be more generous than my insurance!

[m13m]

Its the insurance company lying . I can not  get a prescription. Or a different Dr. even if I wanted one  without their approval.   My specialist said I need treatment now. I saw class action suit in Cal. --that's the next step --if  drug company does not help. If I can find a lawyer in Oregon to go  against the state. Oregon opted  out of  Medicaid.

[Sarah1949]

In Oregon doctors have no problem with lying to you and saying your insurance will not pay and so I won't give you a prescription. I often wonder why no one sues. If you have enough money to sue, then more than likely you have enough to have good insurance. It's the people on Medicaid who are lied to and they can't afford to sue.

[billy776977]

If you are diagnosed with cirrhosis and Hep C the SOC is 24 weeks Harvoni. If your doctor refuses you the prescription they're committing malpractice. Go to another GI doc who will. Submit the prescription to your specialty pharmacy. Apply for the $5 copay from Gilead. All of these companies will help to cut through the red tape. It will also provide a record of denial which will help you to get the drug directly from Gilead as a last resort. I recommended this to someone else in your situation recently, and I am pleased to announce that he has gotten his Harvoni.

[m13m]

I also have hep c 1a --low viral load--first they said I was not sick enough-then they said it would not help my cirrhosis--now there saying HARVONI IS NOT FOR ME. They do not want to pay. contact  the company Gilead they make  it and hopefully they will. That is what I am waiting for. I am in Oregon  they are harder to deal with.

[emarmon]

Thing is, I have no cirrhosis and a low viral load, even though I have probably been infected for 40 years ...... so my understanding is that people like me are low priority. mac790, were you able to get Harvoni through Lilly? And actually, compared to the cost of Harvoni at $80000, $5000 sounds pretty reasonable, and almost within reach if I am willing to trash my retirement. It's frustrating, knowing a cure is right within reach but so very far, far away because of a stupid thing like money.

[mac790]

Hi-- When you say Medicare, I assume it is Medicare Part D, administered by an insurance company like Blue Cross, etc?  If so, you might be in for sticker shock. I had a similar experience w/ Forteo, via Part D, they wanted $5K for 3 months. I went directly to Lilly, and qualified for pro bono meds for 2 years, the limit of tx on Forteo. My understanding is patients with cirrhosis get priority. Other Gilead experienced persons, and there are a few here, can tell you more. Depending upon your income, and your stage of cirrhosis, you may be able to get your meds totally pro bono, side stepping Part D completely. mac

[emarmon]

Thank you! That's good to know. I'll celebrate my 65th birthday by actively pursuing treatment!

[Sarah1949]

I have Original Medicare with Extra Help and was approved on my first appeal. I was denied the first time only because they wanted a Q80K test. Once that was back they approved it. However, my doctor told me my insurance would not approve it and I had to go to another doctor to get a prescription.