I have a hepatitis C patient with cirrhosis who recently started treatment. He's doing great, his viral counts went from 3 million to less than 43. It's working! Then I got his blood counts back, and his red blood cells were low. In following the guidelines, I reduced the doses of his medication. His next counts were still low. I tried to prescribe a red blood cell boosting shot, but the insurance company said no. My nurse has been more than 4 hours total this week talking to his insurance company to get it approved. They said no again today. I will have to fill out more paperwork to petition them again, and I will try to get someone on the phone to explain that if they don't choose to cover the medication, he will need to be hospitalized weekly for blood transfusions and all the risks that numerous transfusions entail.
Hopefully I can convince someone. I refuse to stop his hepatitis medication; he is undetectable and if he remains that way his risk for liver cancer and transplant drops substantially. I'll fill out any amount of paperwork it takes to get this approved, it's just sad that I have to try and explain this to people who know nothing about medicine let alone the nuances of hepatitis C treatment.