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Ended Harvoni 12 tx july 6th looks like it didnt work for me

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Posted 9/2/2015 3:45 AM (GMT 0)
Hi Dennis- I am attaching a link to the AASLD (American Association of Liver Disease) that relates to recommendations for re-treatment-- when someone, like yourself, with Hep C has been treated and the treatment has failed. The AASLD is the most highly respected organization when it comes to determining treatment. I am not certain which specific situation mentioned in this report speaks to your situation but you and your doctor would know and can use it to advocate for treatment and/or the test. If you post which specific re-treatment option listed applies to you we may be able to help you find some research to support your appeal. Once you have your research you may want to file your appeal as an "expedited appeal" to move things along quicker and get you back on some medication faster.

www.hcvguidelines.org/full-report/retreatment-persons-whom-prior-therapy-has-failed

Dear Themiz- could you do your magic and make the above a link for Dennis? Not working for me! Tx!!

Post Edited By Moderator (MamaLama) : 9/2/2015 2:51:09 AM (GMT-6)

Posted 9/2/2015 3:00 PM (GMT 0)
Thanks getcured, i also found that info yesterday and I'm going to submit this with my appeal letter::::

Recommendation for re-treatment for genotypes 1a from the American Association for the Study of Liver Diseases (AASLD) and Infectious Diseases Society of America (IDSA). - 8/17/15

Sec 18. Options for retreatment of patients with HCV genotype 1 whose previous NS5A inhibitor–containing regimen failed.
:
• For patients without an urgent need for treatment, deferral of retreatment is recommended pending the availability of additional data. (III-C)
• For patients with cirrhosis or an urgent need for retreatment, testing RAVs which confer decreased susceptibility to NS3 protease inhibitors (e.g.,Q80K) and to NS5A inhibitors should be performed using commercially available assays. (IIb-C)
• For patients with no NS5A RAVs detected, retreatment with a daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) with RBV for 24 weeks is recommended. (IIb-C)
• For patients who have NS5A RAVs detected but do not have NS3 RAVs detected, treatment with sofosbuvir (400 mg) and simeprevir (150 mg) with RBV for 24 weeks is recommended. (IIb-C)
• For patients who have both NS3 and NS5A RAVs detected, referral to a clinical trial is recommended. (IIb-C)




I think its beyond absurd that the insurance company deems my condition not a medical necessity for retreatment when I have stage 4 cirrhosis a 3 million viral count and ALT 302 and AST 156 at elevations.
Posted 9/3/2015 2:00 AM (GMT 0)
Some decisions are hard to believe, beyond absurd is right. So sorry that you have to go through this.
Posted 9/3/2015 2:39 AM (GMT 0)
Hi Dennis- Here is another link that I found helpful regarding re- treatment. Also, as Barry and Mama Lama said, there are some brand new treatment options that may work for you. It also seems good that your doctor is trying to have you tested to make sure that the next treatment option is the right one for you. We are all behind you so keep fighting.

http://www.easl.eu/medias/cpg/HEPC-2015/Summary.pdf
Posted 9/14/2015 1:20 AM (GMT 0)
Well my appeal was denied again ! The denial letter states they are not an insurance company but a third party administrator for claim processing of services for self funded plans (Employer and member funded. Its my wife health care plan as shes a county worker. They state "Resistance testing were paid buy the plan" and that "explanations of benefits dated 9/25 were mailed to me"...I don't know what they are talking about I never have been tested for Resistance and my Doc told me they refused to cover it. The letter goes on to say I'm not to be considered a medically necessary and that the drug cannot be experimental/Investigational as defined by the plan. It states I have the right to appeal this matter further to the Review Committee designated by the Plan Administrator. It clearly sates no Harvoni or Viekira Pak.......... Cirrhosis @ Stage 4 I feel like I'm on a raft in the middle of the ocean stranded.


Dennis
Posted 9/14/2015 11:40 PM (GMT 0)
Dennis,

Do you have a friend who is an attorney who can help you write the appeal?

Can you afford an attorney.

Can your wife's HR/Benefits Coordinator help you with the formal Appeals Process?

I would be jumping up and down....I hate stuff like this.

Hoping you get to the right people for the appeal.

Hugs,
ML
Posted 9/16/2015 2:47 AM (GMT 0)
Allegiance called stated they believe the resistant testing will be covered according to our health plan. Well I'll least get that done and hope they pay for it. I think that would strengthen my appeal if no resistance was found although I don't know.
Posted 9/16/2015 4:02 AM (GMT 0)
Dennis- Hoping you can try to not get too discouraged-- you really are getting somewhere (looks like you will get the resistance tests) but its slow and you have to keep fighting. I was in your position last year for four months and I know how frustrating it is. I would follow up with Allegiance as soon as possible and get a date for the testing. Just make sure that they have agreed to pay for it and remember to write down the name of everyone you speak with and tell them about your condition and how important it is that you get tested and then treated on an expedited basis. Get your doctor to call if they are not giving you a date within the next few weeks.

At the same time I would also consider taking the next step in the appeal from the latest denial. You can always drop it later if they give you the tests and treatment. You can use the same arguments and any documents you used before and then just add that you had been told that your plan would not cover the testing and that you have not, in fact, had the tests. You may also want to state that the test and treatment you are seeking are not experimental/ investigational. They are specifically set out as the necessary tests/treatment in your situation by the American Association for Liver Disease.

Keep going Dennis-- keep us in touch and good luck.
Posted 9/29/2015 2:05 AM (GMT 0)
Hi Dennis- Thinking about you and hoping that you have been able to work out having the resistance testing with your insurance company and that the results will lead you to a new medicine regimen. GC
Posted 9/29/2015 3:44 AM (GMT 0)
My test came back bad news ....Q80K polymorphism and N5SA resistant. So here I sit waiting with Cirrhosis for so type of new meds. The Doc said he was calling U of Washington to see what is available for trials... I said anything but Interferion. Now what at least I'm not compromised ....yet !



Dennis
Posted 9/29/2015 10:29 PM (GMT 0)
U Washington seems to be doing the research you need.

I found this:

depts.washington.edu/hepstudy/presentations/uploads/103/ledipasvir_sofosbuvir_master.pdf

So you are unfortunately in the 16%.

I think you have me time to find a regimen that works for you. My Mike waited from 2000 until 2014 to find something that worked. He had Hep C 44 years before he was cleared.

Hugs,
Mama Lama
Posted 9/30/2015 1:10 PM (GMT 0)
I had a doctor's appointment yesterday and asked my doctor (a well respected Hep C research Dr.) about your situation. He had specific suggestions and referrals to doctors and potential studies. I have included my email address on my Healing Well profile so you can email me and I will email you back with the details. In the meantime, he said that there were a lot of new treatments coming this year! Hoping that it will help, Getcured
Posted 10/1/2015 12:52 AM (GMT 0)
Thanks getcured . You have mail.

Dennis
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