TOPIC: Criteria for Treatment Decryption

Hi Experts,

Can someone state in plain English who qualifies for treatment under these restrictions?
Thank you.

www.anthem.com/provider/noapplication/f0/s0/t0/pw_e225443.pdf

It was easy for me being Gen 3; I think I dropped out at part (V) - which is fair enough?

I expect everyone else will have to read further on to reach their exit point.



Yours

J.

P.S.

I did notice that following V there was no VI and it went to VII??

I was assuming they are attempting to use Roman numerals?

Sorry Mike,

I just noticed VORORO's post on another thread with respect to the missing VI etc.

Maybe forum members here are showing our age knowing the old number system; even how to read non digital clocks.

Part of me though, thinks that the person who wrote it was not entirely illiterate but perhaps was so focussed on excluding everyone with two legs with a pulse that they made an inadvertent slip with their grammar.

Perhaps they could, in future, submit their drafts to this forum where I am sure some of us older types can assist - not entirely about grammar as mine is not so good either, but with an additional 'fairness/honour/" check?


Yours


J.

Yes,
It would seem easier just to say we will cover you if you are going to die, but not expire in the next 12 months. This is our battle in the U.S. against the private insurance system. Why this site is not overrun with refugees from that situation amazes me. People seem to be so "conditioned" to following the rules and accepting the status quo.
I see no end to it in the foreseeable future.
Mike

I don't have time to address the qualifications paper right now.

However, about people tending to follow rules and accept status quo, I don't think it's so much conditioning as hard wired temperament. I made this point several weeks ago in a private comment to Emilio, but I'll say it openly here because we have a very large potential problem coming.

The demographic we are seeing on this forum is not representative of the population at large. The people here doing most of the talking and taking action on their own behalf are mostly from the ~20% of the population known as "Intuitives," either Idealists like Greg Jefferys or Rationals like Dr. Freeman. We tend to think for ourselves and outside the box, and are far more willing to challenge authority than are the ~80% of the population known as "Sensors."

Sensors tend to need rules and an authority chain to guide their decisions, or simply let someone else decide for them. While Intuitives tend to derive their sense of right and wrong from some philosophical position, Sensors tend to see it based on custom and tradition and the orders sent down the authority chain. It's not that they can't understand, it's that they're not inclined to try.

To make matters worse, most of the people in bureaucratic positions tend to be Feeler Guardians, the most authority chain driven of them all. They are actually threatened by anyone who would dare to think outside the box or challenge their holy authority chain.

To get the Sensors to take action for themselves will be difficult and we'll need to be able to show some serious credibility ... we'll need to appear as the voice of authority. And after that they'll likely be needing their hands held the whole way.

I'm not bringing this up to be condescending to them, I'm bringing this up because I'm very concerned about what will happen when we start succeeding in reaching the larger numbers out there and they simply can't figure the whole process out by reading this forum. There are not enough of us here to hold all their hands.

We've got to get their decision trees worked out such that they can easily follow them and we have to do it before the big numbers start hitting.

Hi Kevin,

"I'm bringing this up because I'm very concerned about what will happen when we start succeeding in reaching the larger numbers out there and they simply can't figure the whole process out by reading this forum. There are not enough of us here to hold all their hands."

I read the first part of your post and it is a good way of understanding how unfortunately the world operates most of the time.

The second part above begs the question of what should the individual do about it. At this time, I am just trying to get better and while doing so I am aware that:

1. people in other countries that should know better cannot access the meds for financial reasons (read gouging).
2. people in a lot of other less well off countries will have trouble affording meds anything - perhaps as our demand pushes local prices up?

and

3. lots of people will not get the message too soon an live lesser lives in the meantime.

So? I guess I rationalise my own actions as me getting better somewhat 'in public'. Anyone who has been involved in my treatment will know who I am from my signature and posts anyhow - if they read this forum.

I have mentioned in a rambling way in other topics that I feel an obligation to 'get better' for reasons of family and not expecting the rest of society to carry me if I get seriously unwell. A bit pious but not judgemental about others - just a statement about being a good citizen with I think a strong correlation with others who give their time (much more than I do) to post their support for each other on this forum. This obligation extends to governments helping as best they can like happened here in AUS.

There is a trite little dog here the Superannuation companies use in advertisements: "from little things big things grow.' There is someone else from the USA who just posted on this forum that they had got their meds from the same place I did here in AUS.


Yours


J.

I don't believe we need to worry about #2. The mad scramble for market share is pushing prices down and the actual manufacturing costs are still far below the retail prices we're seeing. There are so many generics companies at this point that when they all get fully up to speed there will be no shortages. And there are so many people out there needing the meds that I doubt we'll be seeing any of those manufacturers dropping out anytime soon.

#1 will only end when generic competition forces the issue.

As for what individuals can do, I agree that the first and most important is telling people you personally know ... but I also understand the stigma issues and can't fault people who are afraid to do that.

I'm actually working on an idea that has the potential to get the word out to millions, and because of the nature of the method it implies a type of authority that sensors will respond to ... but it has a high likelihood of failure, so I'm not telling too many people yet so as not to get expectations too high. (I need some key people to agree to help and may need more money than I'll be able to find to pull it off.)(and I may need to find some time to fly to Bulgaria.)

I had a call from the Nurse at the Liver Clinic at the Bendigo Base Hospital tonight. I met her when she came to my work place to give us all our flu shots last year. I had only just been diagnosed at that point and we got chatting and she said that she would probably be looking after me at the Clinic...well 10 months and counting and I am still waiting (will have to cancel at some point I guess). Anyway I told her my story and she said that she had had quite a few queries regarding the Buyers Club and now that she has actually spoken to someone who has taken that road she will be able to tell people that do query about it that she has spoken to someone who has taken the generic option and the positive outcome so far. She was very excited to hear of my progress and asked lots of questions regarding blood tests results etc. I was happy to give her all my positive news. Clearly the message is getting out there, even here in good old Bendigo!

The impression I got from her was that the medicos are not prepared to take the risk by writing scripts for generics. She did however say that she wondered how many people would be able to be treated when the meds are listed on the PBS here in March i.e. it was probably only going to treat those whose livers are really compromised......which is a fair enough comment I thought.

A flight to Bulgeria?!! - I'm excited Klhide!

Ya, seeing as you're the one person that knows how crazy my idea is.

Mike knows an earlier version of it.

man I cant wait...watch this space

According to the AASLD:


Compensated Liver Disease:
According to the American Association for the Study of Liver Diseases (AASLD, 2009, 2015),
the specific criteria for compensated liver disease include all of the following: a total bilirubin;
serum albumin; prothrombin time/INR; presence of ascites; and presence of hepatic
encephalopathy. However, these criteria do not establish a comprehensive definition of
compensated liver disease. The AASLD guidance refers to compensated liver disease as
Class A based on the Child Pugh-Turcotte (CPT) classification scoring system.

So anyone with liver disease that has not progressed would be a child A and thus considered compensated Liver Disease

So Anthem has removed the old F-score
Restrictions.
I think....

Care Mark's PA criteria:

www.caremark.com/portal/asset/FEP_Criteria_Harvoni.pdf

Mike said: So anyone with liver disease that has not progressed would be a child A and thus considered compensated Liver Disease

Unfortunately not Mike,

Child-Pugh is a rating of the level of Cirrhosis. So basically a subdividing of those with a F4 fibrosis level. As you are probably aware F4 covers about 14 - 75kPa based on the fibrosis level as measured by Fibroscan/sure, etc. However CP assumes F4/Cirrhosis and then divides it up based on how well the liver is functioning at everyday tasks by measuring blood levels and looking at physical changes rather than just liver stiffness. So someone with CP-A is Compensated or in other words, their liver functions well enough that they can live a reasonably normal lifestyle with some care. CP-B is progressively worse until you get to CP-C. These are both referred to as Uncompensated. Basically it is a point score system that determines likely prognosis.

en.m.wikipedia.org/wiki/Child-Pugh_score

Damn,
I stand corrected.
We are moving backward.

The above info was reply from a moderator on HepMag. You know, the one with all the Harvoni ads.

G, You might want to ease over there and help Lynn moderate
Mike