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Author Topic: Kaiser slow to put Genvoya on Formulary  (Read 4363 times)

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Offline MrPOZ

  • Member
  • Posts: 11
Kaiser slow to put Genvoya on Formulary
« on: January 13, 2016, 03:47:19 pm »
Hello, POZ Posse!

Kaiser is being either cheap or bureaucratic because Genvoya isn't on the Southern California drug formulary and the drug has been available for over 60 days. Does anyone know about Kaiser's process for putting a drug on their Tier 2 "Brand Drug" list? Is there any other part of the country where Kaiser has put Genvoya on their Tier 2 drug formulary? I read that the wholesale price for Genvoya is the same as Stribild so I don't think it is a cost issue but maybe they are bickering over discounts with Gilead. I guess they would rather pay for my kidney dialysis than the increased cost of the meds...

Any information would be helpful. I'm writing a complaint in a couple weeks and I need some ammunition.

Thanks!
Logged
Diagnosed 1/17/2014 VL 157K CD4 200
Start Stribild 2/7/2014
3/23/14   VL  95 CD4 323
4/28/14   VL<48 CD4 300
8/6/14              CD4 413
12/2/14            CD4 494
3/11/15            CD4 355
7/2/15              CD4 366
10/29/15          CD4 406

Offline Mightysure

  • Member
  • Posts: 449
Re: Kaiser slow to put Genvoya on Formulary
« Reply #1 on: January 17, 2016, 03:39:24 pm »
I'm not sure why companies are being so hesitant about this drug but Aetna doesn't want to add it to their formulary either. I have to pay a 250 surcharge for it.  I should've stuck with BCBS of NC b/c they added it to their formulary as soon as it was approved. 
I wonder if an insurance complaint with the department of insurance would help me.
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Offline sreamer17ydr

  • Member
  • Posts: 63
  • Organic Eater!
Re: Kaiser slow to put Genvoya on Formulary
« Reply #2 on: January 22, 2016, 11:55:02 am »
Genvoya was added to Express-Scripts coverage by the new year, and Ohio added it to the formulary for the people on ADAP programs, so at least here, in Ohio and with Express Scripts they updated the lists.

I just got my first bottle of Genvoya today, Jan 22, and I just had to wait from Nov-now for the insurance and everything to go through. I have Express- Scripts, and I have never had an issue with my Atripla or now Genvoya being delivered in the mail monthly on time, or getting meds paid for or added to formulary.
Logged
07/01/09: Tested Poz
08/19/09:20,653           CD4: 566
11/10/09:57,673           CD4: 623
12/13/09:60,000           CD4: 400
02/1/10: 67,000            CD4: 600
02/16/10: Started Atripla
03/29/10: Undetectable, CD4:720
10/27/10: Undetectable, CD4:620
04/20/11: Undetectable, CD4: 816
09/21/11: Undetectable, CD4: 823
04/28/14: Undetectable: CD4: 849 :51%
10/27/14: Undetectable, CD4: 654 :51%
04/01/15: Undetectable, CD4: 623 :43%
11/09/15: Undetectable  CD4  757 :45.9
01/22/16: Started Genvoya
04/08/16: Undetectable, CD4:860: 46.9%
05/03/17: Undetectable, CD4: 659 44.5%
11/01/17: Undetectable, CD4: 509 45.7%
03/01/18: Started Biktarvy
05/02/18: Undetectable CD4: 544 47.1%
11/26/18: ?
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