Sovaldi and Olysio

Hi
I have been following for about a month and admire everyone for there determination and support here. I was diagnosed in '98 with Hep C. I have been to a couple of clinics in Mexico and was able to calm the beast down, but not cure. I am now seeing a Gastroenterologist here and going to see a Liver specialist on the 6th of Aug. My viral load count is 1.4 mil approx. My liver enzymes are slightly elevated about 20 to 30 high. My meld score is 10. I also have some cirrhosis. My Gastroenterologist sent my FEPBLUE a request on July 22nd for Solvaldi and Olysio. I was floored today when I received a letter from BCBS that I was denied. The sentence read, the diagnosis of Hepatitis C in a treatment-naive patient that is eligible to receive interferon therapy does not establish medical necessity for this drug, also more about accepted standard of medical practice, and something about diagnosis code. I am wondering if my Dr. gave them the wrong diagnosis code cd-9 or whatever it is. I was so looking forward to getting this beast in the past in my life. So many people here have been doing so well with Sol and Oly with the light sidefx. I will be talking with my Dr. Tomorrow morning, I think he said last week we might have to resubmit using interferon. I was looking forward to working while on the TX. I am fearful if I get on the interferon what will happen. Any way looks like it will be another week on pins and needles. I already have had the brain fog for months and months, some itching and of course the lack and energy and no endurance. Just knowing for the last week that I may be able to start the good war against this thing has helped me feel a little better for the last week. Any input would help, you guys sound pretty darn educated with our problems and ways to combat it. Thanks for all of you here.

themiz

Sorry I missed it I am GT1a. Thanks for the response, I will ask if Dr. tried "off label", and talk with him about the FDA recommended and/or the alternative.

when you see your liver doc in aug, ask him if you can wait a few months for the next new drug;a single pill, once a day. it
contains sovaldi and ledipasvir. it is better than sol/oly by a few percentage points and easy to tolerate. so working will not be a problem. and since it is approved for geno 1a and b, insurance should not be a problem.

oct 10th is the fda meeting. by december you could be treating.
best
barry

FEPBLUE? So you're a federal employee....there should be no reason why they would deny your claim in my opinion. But BCBS often relents with an appeal, so I've heard. Worth a try. Much depends on how your doctor justifies it all.

I myself have had them for exactly 40 years, same policy, and never once was I denied anything.

Good luck.

mae be here

I did not try to get my hopes up to much but I was pretty positive I would be approved. I'll push a little more to my Doc for some particulars on his approach and see about an appeal. The new LDV/SOF in a couple of months sounds great, but I sure would like to get started. I guess I better remember that good things come to those who wait eh.
Thanks for you support

Good point David, I think that's why it takes so long for SSD...hoping folks give up.

SBH,

My Mike is/was GT 1a. He failed an Inf/Riba treatment in 2003 and was so sick for a long time after. He had a transplant in 2011 but has Stage 3 fibrosis in the new liver...not quite cirrhosis. He is considered Interferon Intolerant. The Sovaldi/Olysio went through on appeal with no problem. He is on Florida Medicaid...so we thought it was a miracle.

Hugs,

Mama Lama

Just wanted to give an update.  I have appealed the first denial with more information i.e. cirrhosis, to BCBS.  They have 7 days to get back to me which will be 8/14.  I met with my Liver Specialist out of Denver, and I asked him to weigh in if I am denied again.  I asked,  if it would make a difference due to his status, and he agreed.  I asked if he was familiar with "Off Label" and he said yes they are using it all the time out of his office.  He gave me his # to call and let him know if it gets denied again, and he will approach it in that manner. So I am walking on pins and needles waiting patiently.  I am not very patient, I want to get on with it, and take this bull by the horns ;-).

I will post and update when something happens. 

I was just thinking, does anybody know if an "off label" tx changes the copay in anyway?

Thanks to all and I am thinking of all of you who are working so hard to kill the beast.

bye