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Author Topic: Cost of MEDS  (Read 3256 times)

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Offline bhurst

  • member
  • Posts: 2
Cost of MEDS
« on: May 20, 2008, 06:05:11 AM »
I have a question. Recently I went back to work and I have medical and prescription coverage. I was on APIC, which is where the state pays the insurance premiums from my old insurance. My co-pays for doctors visits were nothing and everything else was covered and I did not have to shell out a dime. With my new coverage, the co-pays are the same but the co-pay for my meds, well let me say, my mouth dropped when I saw what I have to pay. I am on Combivir and Sustiva which are $100.00 each a month so $200.00 a month for my meds. I make over $50k a year now. Are there any programs that can help me with the cost of my meds? I am in NYS

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Cost of MEDS
« Reply #1 on: May 20, 2008, 09:15:38 AM »
None that I know of. I think most are geared toward ppl who earn $45k or less, someone jump in if I'm wrong. Maybe try to save $4-6 dollars every day so you don't feel the pinch as much. Not saying that to be snarky but because I imagine to be "just over" the typical ceilings for help must leave many people feeling shortchanged. Like being in black, white or gray. Unfortunately, being in gray, hardships often fall on deaf ears because they're deemed less intense. I would like to see the typical caps raised a bit but that's just moi. The enormous messy cost of HIV meds issue is, to me, the single biggest source of heartache

Offline brooklynpoz

  • Member
  • Posts: 71
  • My Babies, Pepper (8) & Rocko (3)
Re: Cost of MEDS
« Reply #2 on: May 20, 2008, 09:34:57 AM »
Yes, sadly, ADAP ( aids drug assistance program) of NYS, has a threshold of $45k or less per year. Try calling the PPA,
1-888-4PPA-NOW , www.PPARX.ORG.
Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.
LIVE , LOVE , LAUGH

Offline dixieman

  • Member
  • Posts: 889
Re: Cost of MEDS
« Reply #3 on: May 20, 2008, 04:08:32 PM »

Be thankful you have insurance... check out the cost of your meds without having insurance and 200 is a small price to pay to get your meds...

Offline woodshere

  • Member
  • Posts: 1,477
  • ain't no shame in my game
Re: Cost of MEDS
« Reply #4 on: May 20, 2008, 04:22:45 PM »
I too have insurance and although my meds are not as expensive as yours, as a percent of income our meds are about the same.  Personally I would not feel right nor do I think I should be eligible for assistance, when there are so many who struggle to pay for their meds.  I think you should be glad that you have the insurance and we both should be thankful that our insurance companies have not moved HIV meds into a tier program where we would have to pay 25-30% of the cost.
"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it."   Nelson Mandela

Online Miss Philicia

  • Member
  • Posts: 24,093
  • celebrity poster, faker & poser
Re: Cost of MEDS
« Reply #5 on: May 20, 2008, 06:41:18 PM »
as a percent of income our meds are about the same. 

Assuming that the OP's user name is a derivation of the Bensonhurst neighborhood in New York City and that you live in Kentucky there are going to be wildly different living expenses.

At any rate, HIVers in any US location need fully to vet their medical co-pay costs before accepting an entirely new job.  If the OP thinks $200/mo is bad and he's currently on 2 HIV meds, which is about as few as one can hope to be on, what will happen down the road when you find yourself needing 10 different medications each month like I curretnly do?
"Iíve slept with enough men to know that Iím not gay"

Offline bhurst

  • member
  • Posts: 2
Re: Cost of MEDS
« Reply #6 on: May 20, 2008, 10:29:24 PM »
Thanks for all the replies. Yes I understand that I should be grateful that I have coverage, a job, and that I am doing great on my meds, my last blood work was cd4 1300 and VL undetectable. I was a bit of a shock since before I went on APIC, when I was working, the meds were $10.00 each so just dealing with HIV was enough, now with the cost going up, well, again it was just eye opening. I hope in the next few years we will have universal healthcare and not have to worry about co-pays and referrals and crap like that.

I checked out the website and I make too much money for ADAP - with my base salary and all the overtime I put in.


Thanks again

PS - yes I am in Bensonhurst, Brooklyn NYC - no better place!!!

Offline david25luvit

  • Member
  • Posts: 1,409
  • Member since March 2005
Re: Cost of MEDS
« Reply #7 on: May 25, 2008, 11:09:44 AM »
$200 a month is cheap....I have medicare and AARP RX coverage and when I fall into the gap
my meds run around $2500 a month.
Lucky for me I'm now in the Catastrophic stage where they're very affordable.
Not to mention I now have RX assistance (Thank God)
« Last Edit: May 25, 2008, 01:27:05 PM by david25luvit »
In Memory of
Raymond David McRae III
Nov. 25, 1972- Oct. 15, 2004
I miss him terribly..........

Offline aztecan

  • Member
  • Posts: 5,398
  • 29 years positive, 57 years a pain in the butt
Re: Cost of MEDS
« Reply #8 on: May 25, 2008, 11:47:12 AM »
I think you should be glad that you have the insurance and we both should be thankful that our insurance companies have not moved HIV meds into a tier program where we would have to pay 25-30% of the cost.

That is happening a lot these days, especially for those with Medicare Part D coverage plans. I also know one person whose employer switched to this system
He takes Atripla, which costs $1,746 a month. His copay, via the tier system his prescription coverage uses, is $422 a month.

This guy makes less than $15,000 a year.

I no longer complain about paying $150 a month.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline aliveinla

  • Member
  • Posts: 247
Re: Cost of MEDS
« Reply #9 on: May 26, 2008, 01:20:39 PM »
Bhurst: can you have your doc change prescription to Atripla so that it becomes one drug and you only pay $100/month?

Just a thought, I know very little about prescription copay, since I was never sick before.

Now I am scared, I have a related question not sure whether I can post here. I work and have California blue cross, it says:

Quote
Drug Rider Coverage   
Brand Name Retail Copayment All $20 

Brand Name Mail Order Copayment All $40 

Generic Retail Copayment All $10 

Generic Mail Order Copayment All $20 

Rx Mail Order Supply Maximum All 90 Day(s)

Rx Retail Supply Maximum All 30 Day(s)

Rx Non-Formulary Retail Copayment All $40 

Rx Non Formulary Brand Name M/O Copayment All $80 

Questions:

1. Does this mean I can order 90 day supply through mail with copay of $20/order?
2. Will the insurance company tell my employer that I am consuming too much meds thus review my status to my boss?
4/24/07: Last tested Neg
1/22/08: First tested Poz
1/30/08: CD4 393; 28%; VL: 44k
3/18/08: CD4 218; 26%; VL: 222K
4/24/08: CD4 402; 26%; VL: lab forgot
7/22/08: CD4 405; 25%; VL: 6,780
10/15/08: CD4 340, 26%; VL: N/A
2/4/09: CD4 394, 26%; VL: N/A
Jun 09: CD4 300, 25%; VL: 4000
Oct 09: CD4 324, 23%, VL: 10K
11/22/09: started Atripla
11/20/11: CD4 405; VL: UD

Offline BlueMoon

  • Member
  • Posts: 665
  • Calling from the Fun House
Re: Cost of MEDS
« Reply #10 on: May 26, 2008, 01:30:30 PM »
Alive, it looks to me like your 90-day mail order cost would be $40 per drug -- assuming it's on the formulary.  Otherwise it would be $80.

Either way that looks like a deal to me.  Mine is $50 plus 20%, or over $1200 for three drugs for three months, plus a $500 annual deductible.  Good thing I qualify for ADAP.
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
02/10-- ......<48.....481.....44
10/09-- ......<48.....277.....46
07/09-- ......<48.....300.....38
05/09-- ........51.....449.....39
03/09-- Added Isentress
02/09-- ........65.....299.....34
11/08-- ........62.....242.....40
08/08-- ........66.....212.....29
05/08-- ......202.....217.....27
03/08-- ....5210.....187.....21
02/08-- Began Truvada/Reyataz/Norvir
12/07-- 273,000.....157.....22
11/07-- 229,000.....209.....22
10/07-- Diagnosis

It's a complex world.

Offline LordBerners

  • Member
  • Posts: 415
Re: Cost of MEDS
« Reply #11 on: May 27, 2008, 02:29:31 AM »
Better to stay unemployed if you can live with family or something like that.  There is no security in employer-provided insurance, and it sounds like you had a pretty good deal going before accepting the job.  (not to mention now you have to work all the time - that is never healthy for anyone).
Please, just call me Berners.. or Baron.

Offline next2u

  • Member
  • Posts: 1,762
Re: Cost of MEDS
« Reply #12 on: May 27, 2008, 03:16:58 AM »
That is happening a lot these days, especially for those with Medicare Part D coverage plans. I also know one person whose employer switched to this system
He takes Atripla, which costs $1,746 a month. His copay, via the tier system his prescription coverage uses, is $422 a month.
This guy makes less than $15,000 a year.
I no longer complain about paying $150 a month.
HUGS,
Mark

that fucking sucks major ass.

im not on meds yet but i will find out soon what my copay for atripla will be. dude, i heard it was like 1500-2000 or so a month sans insurance. oh, the nurse from my ins provider sent me a letter. they want to talk about my health plan. apparently 1 hospitalization due to a heart attack and 3 different drs because of the hiv have raised a red flag. ill be calling the a-holes tomorrow. what the fuck????

also, i'd bitch about 200 a month for copays - id also  be grateful that i was healthy enough to bitch about it and had enough options to barely squeeze by with all the other bills im paying for (like my ginormous credit card debt, car note, car ins, cell bill, land line bill, internet, rent sans roommate, etc...). egh, what to do, what to do.
midapr07 - seroconversion
sept07 - tested poz
oct07 cd4 1013; vl 13,900; cd4% 41
feb08 cd4  694;  vl 16,160; cd4% 50.1
may08 cd4 546; vl 91,480; cd4% 32
aug08 cd4 576; vl 48,190; cd4% 40.7
dec08 cd4 559; vl 63,020; cd4% 29.4
feb09 cd4 464; vl 11,000; cd4% 26
may09 cd4 544; vl 29,710; cd4% 27.2
oct09 cd4 ...; vl 23,350; cd4% 31.6
mar10 cd4 408; vl 59,050; cd4% 31.4
aug10 cd4 328; vl 80,000; cd4% 19.3 STARTED ATRIPLA
oct10 cd4 423; vl 410 ;); cd4% 30.2
jun11 cd4 439; vl <20 ;); cd4% 33.8 <-Undetectable!
mar12 cd4 695; vl ud; cd4% 38.6
jan13 cd4 738; vl ud; cd4% 36.8
aug13 cd4 930; vl ud; cd4% 44.3
jan14 cd4 813; vl ud; cd4% 42.8
may14 cd4 783; vl *; cd4%43.5

Offline sharkdiver

  • Member
  • Posts: 1,350
Re: Cost of MEDS
« Reply #13 on: May 27, 2008, 10:52:11 AM »
Have you thought of starting a HSA  (a Health Savings Account) with your employer?  you can deduct a certain amount from your paycheck each month before taxes and put it towards prescription copays and other health related costs. The rest can accumulate like a reitrement accountOf course you have to have a high deductable insurance to set this up and you might have to pay state taxes on the money. There are other considerations of course.

My employer set this up with our company and it has been a big help. Once I meet the deductable for the year which is 1500 I don't have to pay out of pocket ( I usually have to pay out when I first refill my meds in the beginning of the year). When I worked in the schools I really didn't have to worry too much about insurance and retirement as much as I do now in a private setting. It was quite a shock

Sharkie

Offline Iggy

  • Member
  • Posts: 2,435
Re: Cost of MEDS
« Reply #14 on: May 27, 2008, 03:22:02 PM »
Hey Bhurst,

I very much appreciate what you are talking about.  When I first moved down to N.C., they had me on Ryan White Funding and my doc appointments and meds were covered.  Since moving on my partner's health insurance (which is what most would consider to be a more fortunate position) we have had a hard time making medical expenses.

Doctor appointments are $40/each (so $80 a visit) and meds copay right now are ranging between 25-40 a drug copay.  With a couple of other immediate need expenses (rent/car payment/food) we had put off me starting meds myself three times simply because we just weren't certain that we could meet the monthly expenses of my partner's prescriptions plus my new ones together for the last three months. 

Frankly with the cost of gas alone, my doctor appointment and one prescription is a few weeks worth of gas just for commuting to work purposes.

I am aware that we are better off with a $200-300/month expense then others who have no income at all, but I just wanted to say that I understood your feelings on this issue.

Online Miss Philicia

  • Member
  • Posts: 24,093
  • celebrity poster, faker & poser
Re: Cost of MEDS
« Reply #15 on: May 27, 2008, 04:12:54 PM »
If Jeromy's insurance coverage for you is preventing you from getting proper care and medicine, why on earth did you switch from RW/ADAP in the first place?  Can't you switch back?
"Iíve slept with enough men to know that Iím not gay"

Offline Bucko

  • Member
  • Posts: 1,947
  • You need a shine, missy!
    • The Spin Cycle
Re: Cost of MEDS
« Reply #16 on: May 27, 2008, 04:38:51 PM »
Yes, sadly, ADAP ( aids drug assistance program) of NYS, has a threshold of $45k or less per year. Try calling the PPA,
1-888-4PPA-NOW , www.PPARX.ORG.

Last I checked, the threshold in Florida is $30,000. When I lost my health insurance I also lost most of my earning potential. I've never recovered from the economic havoc that caused.

Brent
(Who should probably just be on Disability)
Blessed with brains, talent and gorgeous tits.

The revolutionary smart set reads The Spin Cycle at least once every day.

Blathering on AIDSmeds since 2005, provocative from birth

Offline LordBerners

  • Member
  • Posts: 415
Re: Cost of MEDS
« Reply #17 on: May 28, 2008, 01:02:53 AM »
...When I first moved down to N.C., they had me on Ryan White Funding and my doc appointments and meds were covered.  Since moving on my partner's health insurance (which is what most would consider to be a more fortunate position) we have had a hard time making medical expenses.

No, in the US private insurance is generally much worse than being on a charitable or government program.  The only exception would be insurance provided through a good union (very few of those left).  You see, insurance in the US is run for profit, so they will always attempt to deny care, kick you off the rolls, or increase 'your share' of payments.  Worst of all is insurance connected to a job - we all know what tenuous, unreliable, and shakey things are jobs.. after all once you are significantly ill they will simply fire you, no?
Please, just call me Berners.. or Baron.

Offline Iggy

  • Member
  • Posts: 2,435
Re: Cost of MEDS
« Reply #18 on: May 28, 2008, 12:38:54 PM »
If Jeromy's insurance coverage for you is preventing you from getting proper care and medicine, why on earth did you switch from RW/ADAP in the first place?  Can't you switch back?

We honestly didn't forsee certain circumstances including my lack of any serious employment; He is carrying an unfair burden right now of supporting both of us and that has stretched income thinner than we assumed it would be when we decided to put me on his insurance.  Add some unexpected bills on both of our parts (I'm still fighting with the hospital and labs about my several thousand dollar shingles stay - since I checked in before Jan 1, it is not covered under Jeromy's insurance) and things as simple as rising prices on a host of items (food and gas in particular.)

As for moving back onto Ryan White, it is something that I need to talk with my Doc (who arranged my placement on it when I first got to NC) when I have my appointment next week.  We also have to check with Jeromy's health plan.  In truth though, I do not think it is possible as I think we have to wait until the enrollment period for his plan to remove me. 

I want to stress that we are managing and since I've been in general good health each time the doctor appointment gets near, we have made a conscious decision to postpone the costs of me starting the meds (plus the doctor's visit.)  The issue to keep in mind to was to make certain we could sustain a budget commitment for the monthly med costs as we didn't want to fool around with me starting meds one month and then having to take a break of a week or two here and there when we couldn't afford it once in a while.

We should hopefully be alright in the next couple of weeks, but to bring this back to the original topic, there is something so fundamentally wrong with out health care system in the U.S. when people have to struggle just to be able to make a doctor's appointment or to afford meds even with good health insurance.



Offline Florida69

  • Member
  • Posts: 428
Re: Cost of MEDS
« Reply #19 on: May 28, 2008, 02:34:21 PM »
there is something so fundamentally wrong with out health care system in the U.S. when people have to struggle just to be able to make a doctor's appointment or to afford meds even with good health insurance. 
  MAN AINT THAT THE TRUTH...   

I spend 225/month for insurance then I spend 550/month for meds.  I have very little money left for anything else, so what I am doing is spending my savings down on necessary things.  I figure you can't take it with you, and it is only a matter of time before I go broke.  Good luck there Izzy, I hope  you find the way that works best for you..   D
Nothing in the world can take the place of Persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan 'Press On' has solved and always will solve the problems of the human race.
Calvin Coolidge

 


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