POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: hereformyfriend on January 28, 2011, 05:52:37 pm
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Hi everyone! I wanted to ask some questions for my cousin's BF. He is on Atripla, and pays out of pocket private insurance $700/month to Oxford. That is 20% of his salary. He is going to apply for ADAP, although his gross income is higher than the guidelines, his net income falls under.
So, if they do not approve him, and he cannot apply to Apic to cover his premiums, are there other options? Is there anyway to lower his premium so it will become affordable? Are there other options for people who have too high an income... LOL.... which is ridiculous, since his income barely covers his expenses. Are there any recommended insurance carriers that cover atripla, and don't charge so much? As in a diff private insurance provider? We are in NY.
Any advice will help.... I have called many agencies, and I am not getting anywhere. But I am hoping adap comes through for him. Which, really, it ought to since his actual income is below the guieline.
I am waiting to hear back from some other agencies, so maybe there are more options.. but I figure if any of you are in NY, you certainly know how it works!
Thanks a million!!!
;D
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The Atripla co-pay assistance program will cover $200. of that co-pay every month. That still leaves him paying $500 which is a lot so maybe he would qualify for ADAP depending on his income.
Here is a link with some info, the co-pay assistance program is very easy to sign up for, just call the 800 number.
LINK:
http://www.atripla.com/hiv-med-cost.aspx
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Hi! Thanks so much.... but this confuses me.... isn't that $200/month for the prescription co-pay at the pharmacy? Or is it $200 off of the insurance payment? Because I thought atripla gives you a card to bring to the pharmacy to cover the co-pay payment only? I am not good at understanding insurance stuff. I don't know what his pharmacy co-pay is to get his meds, but could be upwards of $100 a month. Maybe more. But then he still has the $700 payment to make. I was looking at the atripla link before as well, and I think they also use the same income guidelines... but i could not find the income cap. This should not be so hard :( But since you brought it up, I will call them as well. Even the co-pay at the pharmacy being covered is helpful. Thanks!
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It's $200 off for Rx at the pharmacy, did you say his co-pay is $700 each month for Atripla?
The co-pay assistance has no income guidelines, it does not matter what the income is. He just calls the 800 number to sign up and if he has insurance he qualifies. It is for people who have insurance and have a co-pay. He then can use the card at the pharmacy and it covers up to $200 maximum each month so if his co-pay is normally $700 they would deduct $200 and he would still have to pay $500.
At least it's something for now until he is able to maybe get ADAP. If he filled a prescription recently he can send Bristol-Myers the receipt and I believe they will reimburse him for co-pay assistance for something paid in the last 30-60 days, he can ask when he calls the 800 number.
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Oh, ok, great, that is good to know. I actually meant his insurance plan payment is $700 a month. So his co-pays are an extra cost. But i will tell him he will get approved to atelast cover the meds. That is really great:) Yea, I am really hoping he can get Adap/Apic. His $700 insurance is oxford, and they cover the cost of the atripla, luckily. Not the copay. I guess that is why it is so expensive. But thanks I will pass that on to him now. That is terrific :)
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Inchling, he means he pays an insurance premium payment of $700/month to Oxford (HMO) -- that has nothing to do with what his co-payment is at a pharmacy. The premium is so expensive because it's a "single", not part of a group plan. It has nothing to with being HIV+ and on Atripla.
Otherwise is you don't qualify for ADAP you don't qualify for APIC, it's the same financial criteria. It's based on gross not net income. So if you're over the limit that's it, you won't get it.
Have you sat down with a case manager at GMHC's Legal Dept. to make sure all bases are covered? I suspect all you're going to get is co-pay assistance and you're stuck paying $700/month, but you should still go over this with a case manager.
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I called GHMC today, and they said he has to go in person to get a case manager. I called the NYC branch (where I live). Not sure if there is one in the burbs where he lives. I will look it up. I actually called Adap, and they said he can submit a notarized income statement with his application, (since his net is below the guidelines) and they will consider all the information. So, she made it sound hopeful, but I really don't know. And yes, it would be nice if there were a cheaper plan available for him. That is really what I was looking for. Or somekind of back up plan/ assistance that could cover some of that payment to oxford. But this is complicated, and his employer does not help pay his premium. But that was another good piece of advice, so i will see if there is a local GHMC for him to go to. And maybe they will have an idea for him. I don't know if he already contacted them. But i am guessing not, since he is paying out the wazzoooo!!
Thanks for all your suggestions. At least I'm on the right track. But it is not looking good. If anyone else knows of any cheap plans that cover meds, let me know!
Thanks!!
:)
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Nope, I see no links to other addresses at GMHC. They told me the services are available to city residents only. :(
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The Atripla co-pay assistance program will cover $200. of that co-pay every month. That still leaves him paying $500 which is a lot so maybe he would qualify for ADAP depending on his income.
Here is a link with some info, the co-pay assistance program is very easy to sign up for, just call the 800 number.
LINK:
http://www.atripla.com/hiv-med-cost.aspx
To clarify this thread, the 700 is the monthly premium to his insurance company. It is not his copayment on the drug.
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There is insurance called Healthy New York, which is subsidized by the State. There are some income guidelines but maybe he would qualify. If he pursues it he should check what kind of prescription coverage they would offer and what kind of coverage in general. And he should try not to let his insurance lapse while he is looking for alternatives.
He can still use the Atripla co-pay I mentioned above for whatever his co-pay is at the moment, I assume he probably has some sort of co-pay.
The Healthy NY program is designed to assist small business owners in providing their employees and their employees’ families with the health insurance they need and deserve. In addition, uninsured sole proprietors and workers whose employers do not provide health insurance may also purchase comprehensive coverage directly through the Healthy NY program.
LINK:
http://www.ins.state.ny.us/website2/hny/english/hny.htm
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The bottom line is that he should sit down with a case manager. If you can't go to GMHC because you live outside of NYC then you need to research where you go for a case manager. I would think that the county that the person in question resides in has a department of health that can refer you to the proper phone number.
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HI Inch! Thank you! I know he talked about Healty NY. There must be an issue with that plan, since he doesn't have it. But I will ask again and make sure that is not an option... And he def won't let his insurance run out. He needs his meds everyday. Atleast he is covered for now. And MissP, I will see about a case manager for him. I also emailed GMHC to see where he can go, if he can't come to their office. You are all very helpful!! I called someone in his city, they said they couldn't help me, then they gave me soneone's cell. I haven't heard back from this person yet... he has somthing to do with adap. But not sure. I really hope adap comes through for him. How often do you have to reapply? Fingers crossed!!!!
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Hey everyone.. just a quick thank you.... My friend got his atripla approved, so no more co-pays. :D he is working on his ADAP app now :) thanks a lot and good health to you all!!! Your help is much appreciated! xoxo