Sometimes having the best medical team isnt enough if you don't have someone who.knows how to do a good appeal. There is a set of rules when writing these darn letters!

So right Gooser1. My understanding is that this medical center in Houston is quite familiar with the process & submitting the documentation. Multiple denials & appeals are not uncommon that's for sure. After failing 48 wks std of care, my doc sent a pre-authorization for triple tx with Incivek when that came out. Denied. My doc submitted an exception request. Denied. Doc submitted appeal. Approved. Of course it didn't work either. It is certainly not uncommon & it's even more difficult in 2014 sometimes requiring multiple appeals.

Amazingly enough, by the time these appeals go through for you guys, the new meds will be out. Geez.

That might be true..but its no quarantee that insurance will pay for the new stuff....I doubt its going to be much cheaper..

I don't quite understand "off-label" I know it means being prescribed a medication that was approved for a different illness, but it is still an FDA approved medication and not experimental. My son needed a medication when he was under 18 and was prescribed a medication that was approved for a different illness than the one he had and my insurance paid no problem. That's why I don't understand why if it is an approved drug, what does it matter what it is prescribed for?

So can people get marijuana 'off label"? Just kidding. That is a good questions Jaro. I mean we all understand it to be the pure cost of the medications used together is the issue with insurance companies, but then again, INF, Riba, AND incivek or victrelis were combined, so what is the difference? The cost of all 3 of those MUST have been the same astronomical price collectively....or more.

Perhaps it is simply that they are FDA approved separately when they came out, but not in combination with each other? We ALL know that they work just fine together. And, it has been cited that the study, small as it was, showed this.

Not just the cost of the meds for triple tx, but the management of the horrible sides - like transfusions at times - up the cost considerably. So far, and I think this will hold, I know of no one who has needed rescue meds for Sovaldi/Olysio. For the headache, certain NSAIDs or Tylenol, depending on your personal health status, may be used (with caution). The only other side effect that I've read about (personal stories, not the blurbs about the meds) is fatigue. Don't need rescue meds for that - just need to go with it, lie down, rest, stop pushing.

There has been a virtual bombardment on the insurance companies for Sovaldi to treat HCV patients. THAT is their "problem" - how much this will cost THEM to have to pay for all these meds "at once." When "they" realized, by mid-February, just how great the demand was for Sovaldi, the insurance companies put the walls up. Too bad - like aal has said, that's why people pay their insurance policies year after year after year - not just for the "normal" kind of issues to be covered, but for the major ones too. HCV is major. The insurance companies simply don't want to fork over so much money all at once - and honestly, the cost of Sovaldi is ridiculous. Olysio isn't that much cheaper. But GEE, these drugs and the others on the way, just MIGHT cure people of HCV, thus alleviating the cost of transplants and the many other HCV related issues that arise over the course of harboring this virus.

Bah, humbug. (I almost wrote "hamburg" - huh?)

And people act shocked when someone goes postal. Not referring to you jaro just situation. I wonder if the answer would be the same for the bosses ol lady. Good luck peace