Hep C Treatment after successful HCC treatment in New Zealand

ML- Mikes friend will need to look at the criteria that his insurance plan requires an insured/patient to meet in order for them to receive prior approval for Hep C medication? Then he will need to determine if his condition meets that specific criteria. Its very possible that he does meet the criteria but that his doctor may not have provided all of the information (tests, case notes, etc) to the insurance company.

Many of the insurance companies use the priorities for treatment set out by the American Association for Liver Disease and many have only agreed to treat those with the highest level priority for treatment (stages 3 or 4 or specific "extra hepatic manifestations" of Hep C). Even if he does not have stage 3 or 4 he should qualify as meeting a high priority for treatment having had liver cancer. The priorities for treatment are set out in the site below. He should work with his doctor to gather more information about his condition and research about the very real danger of getting liver cancer again if he is not treated for Hep C. They should put this in a clear letter to the insurance company along with all supportive tests/notes and research that they can file as an appeal. There is a lot of supportive language in the AASLD about the importance of treatment for those with a high risk of getting liver cancer.


www.hcvguidelines.org/full-report-view


He will also want to see if he meets the financial criteria for help from the pharmaceutical company patient assistance programs for the medication he requires which I assume are Sovaldi and Riba. Websites for those programs are listed in the document I posted last week called What to Do When your Insurance Company Denies you Treatment for Hep C?


Finally, he may also want to contact the Patient Advocate Foundation hotline at 800-532-5274. They have a new and special Hep C unit that helps people with difficulties they have getting approval from insurance companies. If he calls them, ask him to let us know if they are helpful.


Finally, sorry for all that you and Mike are going through. You are so generous to help others as you face such tough times yourself. We all appreciate it so much and have you in our thoughts and prayers. GC

Post Edited By Moderator (themiz) : 2/9/2015 8:37:37 AM (GMT-7)

Yes...the system is quite different. He was asking whether there was a medical reason you could not treat post cancer.

And get cured has a good point...that continued infection with Hep C virus increases risk of more tumors...so best one gets cured SOONER THAN LATER.

The countries with national health systems have protocols for treatment such that they take the amount of money they have for a certain drug and approve it for what, in their best thinking, are the most likely to need it immediately.

I'm not sure sovaldi is even approved by their version of the FDA yet.

He is so discouraged and seems to wonder why the med system approved his cancer treatment if they were going to let him die anyway. Sad...I bet a lot of folks feel this way. He is an American expat so he thinks about the differences in systems a lot.

Having lived in both AUS & NZ, the health care systems are very different to that of the US or even Canada.
As a general rule (not always the case) folks there wait for years to access treatment currently available in the US. Most often when the treatment is offered as a generic or similarly discounted world wide.

For example the shingles vaccine is still not available in AUS of NZ yet, it is simply too expensive.

The best place to look for answers would be a Hep C support organization. I know there are several in AUS, not sure about NZ.

Hope this helps.