Over $2000 for a month of Atripla?!?

[Phoenius10]

Who in their right minds would actually pay thousands a month out of pocket for these drugs??  I know I sure wouldn't, especially when they are giving them out free like candy to others.

It makes me wonder.  Is my insurance company actually paying that?!  No wonder health care costs are spirling out of control.  The pharmacy companies are riping off everyone, except the needy.

I'm not exactly needy so I'm pretty sure I wouldn't qualify for any assistance programs (if I was being honest lol).  But I do know one thing is for sure, it wouldn't take me too many years to actually become needy if I did have to pay over $2k a month for these drugs!!

Unfortunately, I'm on Cobra and it expires later this year.  I'm wondering how much this extra expense will actually increase rates for my old employer's group plan.  haha  That makes me chuckle.  LOL

Fortunately I was in the military and it looks like I'll be able to get Atripla for only $8 or $9/mo through the VA, which is even a better deal then the $20 I currently pay with Cobra.  But being self-employed and making only enough to pay for my basic expenses, I doubt I'll ever be able to get real health insurance again.

But then here comes Obama, and the healthcare reform with the high-risk pool possibility.  We'll see how that plays out, but I'm not sure why they'd make me have to sit out without insurance for 6 months to qualify for it.  I'm still baffled about that.  But if the VA plan works out, I might just wait it out until 2014 before trying to get real insurance again assuming Obamacare is still with us.

[Hellraiser]

I believe even ADAP pays some exorbitant rate for Atripla, however I'm not exactly sure of that.

[Inchlingblue]

I believe even ADAP pays some exorbitant rate for Atripla, however I'm not exactly sure of that.

They negotiate a discount but it's still a pretty high amount.

But then here comes Obama, and the healthcare reform with the high-risk pool possibility.  We'll see how that plays out, but I'm not sure why they'd make me have to sit out without insurance for 6 months to qualify for it.  I'm still baffled about that.  But if the VA plan works out, I might just wait it out until 2014 before trying to get real insurance again assuming Obamacare is still with us.

Yes, I think the 6 month wait period is ridiculous. We're talking people who have serious health issues, be it HIV or cancer or whatever and they're being told to wait six months with no insurance until they qualify? It's absurd.

If you can qualify for VA benefits you're all set, very lucky. If I were you I'd start the ball rolling with that.

[tednlou2]

If you were in the military, why are you even paying the high costs of COBRA?  I know my friend was in the military and he gets his healthcare from the VA even though he has a private job with insurance.  He gets all his meds from the VA and sees VA docs.  I'll ask him whether his private insurance is responsible for any part.  COBRA for a single person is like $900/mth, isn't it?  I know it depends on the employer and the plan, because with COBRA you're paying your share plus what your employer was paying.   

[mecch]

Well Phoenius you're new to all this, and yeah the cost is a shocker.
When I was going to start HAART; I picked up a few months supply it was in my backpack and I saw a friend and insisted he come for a beer. I don't normally smoke but I smoked cigarettes and had a beer with him to calm down and one of the things that freaked me out was how much money worth of drugs were in my backpack. I dont usually carry ANYTHING that valuable around.  
I was counting my blessings - as should you - that in my situation it is all affordable with insurance and copays (for me, 700 a year).  
But I was freaking out because it seems that I always have to be sure to have it covered, for the rest of my life.  As an American, this is a fearful thought, and I don't automatically assume its shouldn't be a fear since I'm living in Switzerland where we have a very secure safety net.

As for the cost of my HAART as a burden to society - I rationalize that away since it is shared by everyone in my rather large insurance company.  There are many expensive illnesses around. Society bears the cost of many things but selectively. For instance - taxes pay for universities in my country, so they are practically free - but not everyone gets to go to university.  The cost per student is no different than in the USA, its just the individual student isnt paying for it.

And it goes on and on.

Also, consider, that the price I pay for HAART in Switzerland, among the highest price in World with the USA, comes in tandem with the fact that its the USA and Swiss pharmaceuticals who research these drugs. So the profit they make within the country, at least, is offset by that profit being part of the GDP - the country's general wealth.  Though of course profits are payed out to dividends to shareholders around the world, in addition to salaries to scientists and executives within the companies.

If citizens and the government of Haiti for example, had  to shell out of their own pockets the same price for HAART and all that money was leaving the country, it would be revolting, if also impossible to afford anyway.

I think there are things one can actively do if one is really concerned about these questions of price and supply, globally.  One could work in the NGOs that work on this issue, for example.

I don't think there is much grass-roots activism left about the cost of HIV drugs in rich countries.  Maybe I'm wrong on that.

[David_CA]

It makes me wonder.  Is my insurance company actually paying that?! 

My insurance pays $2700 plus for a month's prescription of Atripla.  If you want to know how much yours is paying, you can ask the pharmacy or call your insurace company and ask.  BTW, the cash price at my pharmacy is $1700.

[Hellraiser]

$60 bucks a pill. 

[Phoenius10]

If you were in the military, why are you even paying the high costs of COBRA?  I know my friend was in the military and he gets his healthcare from the VA even though he has a private job with insurance.  He gets all his meds from the VA and sees VA docs.  I'll ask him whether his private insurance is responsible for any part.  COBRA for a single person is like $900/mth, isn't it?  I know it depends on the employer and the plan, because with COBRA you're paying your share plus what your employer was paying.  

First, Cobra for me is only $100/mo after the subsidies.  This will be expiring later this year.  And second, I'm currently in Priority 8a group with the VA, which means over a month wait to get to see a doc.  I'm still waiting for my first appointment.  When I had a real job, it was only $50/mo for health insurance so that was a lot less pain and hassle then dealing with the VA.  But things have changed.  So it looks like a month to see a doc is what it will be with the VA soon.  Hopefully with the quarterly ID doc visits, he can take care of most of my other needs too.


And yes, if you have private insurance, it pays before the VA.  So who knows, it might cover my copays with the VA until it expires.

[Inchlingblue]

My insurance pays $2700 plus for a month's prescription of Atripla.  If you want to know how much yours is paying, you can ask the pharmacy or call your insurace company and ask.  BTW, the cash price at my pharmacy is $1700.

I don't get it, unless I'm reading it wrong. If the cash price is $1700. why would the insurance pay $2700.?

[David_CA]

I don't get it, unless I'm reading it wrong. If the cash price is $1700. why would the insurance pay $2700.?

You're not reading it incorrectly.  $27xx is the maximum that my insurance will pay for a 30-day supply of Atripla.  Basically, my drug plan covers me for whatever a pharmacy may charge for Atripla.  Pharmacies know this and charge insurance the highest amount they can.  It's weird.  They'll pay a negotiated lower rate for Dr. visits, procedures, etc for Dr's and hospitals in our plan (just about all of 'em in this area).  I don't know why they don't do the same for meds.  I know they'd save at least $12,000 a year for one employee for one prescription.

[Inchlingblue]

Wow, I didn't know that.

When I first went on meds I was able to fill the Rx anywhere but after a few months the insurance company sent me new information saying I had to use a mail order pharmacy (only for the HIV meds, other Rx I could use any pharmacy). It's actually very convenient and they have great customer service but I wonder if they did it because other pharmacies charge them more?

[David_CA]

Wow, I didn't know that.

When I first went on meds I was able to fill the Rx anywhere but after a few months the insurance company sent me new information saying I had to use a mail order pharmacy (only for the HIV meds, other Rx I could use any pharmacy). It's actually very convenient and they have great customer service but I wonder if they did it because other pharmacies charge them more?

Probably so.  Here's an idea for my insurance company  - fill my HIV Rx's via cost controlled mail order and don't charge me any copay ($35).  Sure, it'll cost them $35 a month, but it'll save over $1000.  It seems like a no-brainer to me.