POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: Niceguy2013 on January 05, 2014, 07:32:17 pm
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Does anyone have experience with United Healthcare Insurance Company? I understand they consider once a day HIV regimens a specialty medicine. Would like to know what kind of copays they have. Apparently they use OptumRX for specialty medications.
I've only had blue cross in the past and that was before I started hiv treatment. I'm receiving medicine through ADAP right now and am a little nervous about not being able to afford my medicine .
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I am on a United Healthcare plan through my employer. I take Striblid and, yes I have to order through OptumRx. This is a recent change. Prior to July 1, I could use the Walgreen's Specialty located in the same building as my physician. OptumRx is hit or miss service wise. At times it is almost like dealing with an off shore call center.
My copay is $60 per 30 day supply. OptumRx does not provide 90 day refills. In their favor, they do accept my Gilead co-pay card which covers the entire co-pay making my out of pocket cost $0.
Please note that this is all dependent on which UHC plan in which you are enrolled. Your mileage my vary.
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Thanks for your reply. I read that my copay through optumrx will be a maximum of $100 per 30 day supply. I think atripla will assist up to $1200 per year so it should work out OK. Now to worry about my doctor visits and lab work copays.
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Like piscina said you should apply for the Gilead Co-Pay assist card. You will pay nothing out of pocket they cover I believe upto 240 a month. Just have to register for it pretty simple. Atripla, Complera and Stribild all use the Gilead card.
I too have United Healthcare through employer and I get to go to the pharmacy of my choosing. I guess it depends what the employer chooses. My copay is $40 but the copay assist card wipes that out.
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Probably a dumb question but is there a certain income level where co-pay assistance is not available?
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As for income, I don't think so. I called the Gilead copay assistance number today and they went ahead and signed me up. Gave me a plan number, bin number, and member number. They told me as long as I want getting medication through government assistance (ie, Medicaid) that the card would cover up to $400 copay each month.
They did not ask me about my income at all.
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Wow that is great. Thank niceguy!
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They told me as long as I want getting medication through government assistance (ie, Medicaid) that the card would cover up to $400 copay each month.
They did not ask me about my income at all.
They don't ask about your income because that's already taken care of by the fact that you are on a form of government assistance. It's already assumed that you are below a certain income threshold.
It may be different for people with high(er) salaries who do not require programs like Medicaid.
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The manufacturer co-pay assistance programs do not look at income. You just need to be on private insurance to qualify. You can make a lot or a little -- doesn't matter.
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I meant to say wasn't . I'm not on a government assistance program. They still don't look at income.
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They don't ask about your income because that's already taken care of by the fact that you are on a form of government assistance. It's already assumed that you are below a certain income threshold.
It may be different for people with high(er) salaries who do not require programs like Medicaid.
I'm not on any government assistance programs. I do have a job that pays well they did not ask a single question about income.
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FYI the number for Atripla copay assistance is
1-866-290-4767
I called a generic Gilead number and was asked which medication I was taking.
1-866-664-5327
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I just went to Gilead's website and signed up for their co-pay assistance. To do that go to www.gileadcopay.com and click enroll. No questions are asked about income and you can get the card immediately by printing it out or saving it to your phone. It took me about 2 minutes total. Be warned That it does require that you give an address as a paper card will also be mailed to you.
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Good job. Congrats!
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Thank you again for your help. I appreciate it.
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You're welcome. I just hope other people who are struggling with copays will find this resource.
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Finally got my first script filled. $100 copay for 30 Day supply. Gilead copay assistance covered the whole amount. The only issue I had was that copay assistance only works for 30 Day supply at a time. The specialty pharmacy set me up to email and remind me when it's time to refill.
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after the first month you might start getting a 90 day supply for a co -pay of 100.00,at least thats what cvs speciality did with me and the c0-pay assistance cards took care of that!!
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Great. I will have to check into that.
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Hi
You can get 90 day supply of Atripla from optum RX or from a private pharmacy that are approved for 90 day supply as long as your doctor write a 90 day supply on your prescription.
I have united healthcare and got a 90 day from optum RX last year, this year I have the same insurance but moved to a private pharmacy because optum RX are difficult to deal with.
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I think the issue was the copay card not covering a 90 day supply. The insurance company said that they would cover up to 400 per month but not a 90 day supply. Works out OK because they call to remind me every month and I pay $0 out of pocket.