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Author Topic: Humana 2009 Drug Formulary  (Read 4083 times)

0 Members and 1 Guest are viewing this topic.

Offline Ric Wilke

  • Member
  • Posts: 573
  • I joined AIDSmed.com 10/2002.
Humana 2009 Drug Formulary
« on: December 17, 2008, 07:09:40 PM »
I just got a "love" letter from Humana giving me a heads up that Epzicom is being moved from Tier 2 to Tier 3.  This means that my co-pay for a 90 day supply will go from $300.00 up to heaven only knows.  Humana can't (or won't) answer any of my questions.  Nor will they tell my what prompted this change.  They did say that I could file a "Grievance/Appeal".  Like that is going make them change their minds.  I'm pissed, big time.

Offline J.R.E.

  • Member
  • Posts: 7,221
  • Joined Dec-2003 Living positive, since 1985.
Re: Humana 2009 Drug Formulary
« Reply #1 on: December 17, 2008, 08:10:30 PM »
Hello Ric,

I also take Epzicom and also on Humana.  If I understood it correctly, and I received a letter also , my monthly co-pays were going from $30.00 to $50.00 per month. I don't receive my meds on the 3 month plan. From tier 2 to tier 3. I will officially know the cost when I renew on January 1st,09

Make sure to look into GSK's  Supportcard @  www.mysupportcard.com   I've mentioned this to my doctor, but still haven't heard back as of yet. It could be a savings of 100.00 per month. See if you qualify for this. I will be mentioning this again in January, to my doctor.


Peter mentioned in this thread :

http://forums.poz.com/index.php?topic=24209.0



Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 8/2514,  t-cells are at 402, Viral load <40

 Current % is at 11%

  
 62 years young.

Offline YaKaMein

  • Member
  • Posts: 368
Re: Humana 2009 Drug Formulary
« Reply #2 on: December 17, 2008, 08:37:08 PM »
Just curious. Is either of your insurances a with Humana a Medicare, part D plan? or are these non-Medicare related policies? I hope there's some relief for Ric if his copay may surpass $300/mo and a way for Ray to reduce his copays. How might your copays change for other meds, if on any?
09/11 Endocrine Consult
08/11 CD4 328 14.9% VL 0
 Disc'd Bactrim DEXA -3.1 Tscore
03/11 CD4 338 14.7% VL 0
11/10 CD4 300 14.3% VL 0 <20copies
07/10 CD4 336 14.0% VL 0 DEXA -2.7 Tscore
03/10 CD4 308 13.4% VL 0 Vit D normal
01/10 Began FOTO
11/09 CD4 274 13.7% VL 0 Chol 173 Trig 131
07/09 CD4 324 13.5% VL 0 DEXA -3.1 Tscore lumbar
03/09 CD4 207 10.9% VL 0
11/08 CD4 227 10.3% VL 0 Chol 176 Trig 156
04/08 CD4 228 9.5% VL 0
01/08 CD4 194 9.0% VL 0
09/07 CD4 176 8.3% VL 0
03/07 CD4 130 9.5% VL 0 Chol 261  Trig 227
12/06 CD4 109 6.4% VL 0
09/06 CD4  88 5.5% VL und desens'd rtd to Bactrim
08/06  Began Atripla
07/06 CD4  59 5.0% VL 145 Chol 117 Trig 104
06/06  Bactrim rash, X2 Dapsone
 EFV & Truvada Chol 128 Trig 131
05/06 CD4  6 (2.0%) VL 78667 only V179D mutation Dx PC MAC

Offline aztecan

  • Member
  • Posts: 5,400
  • 29 years positive, 57 years a pain in the butt
Re: Humana 2009 Drug Formulary
« Reply #3 on: December 17, 2008, 11:38:26 PM »
I am seeing this type of thing happening a lot more often than I would like.

This "tier" system can be terrible. One person I know has a tier 4 medication, meaning he is required to pay a percentage of the drug cost, not a basic copay.

He pays $431 a month for Atripla. That just went up last month. It had been $422 a month.

I know I couldn't afford a copay of that sort. Luckily, there is a program here that covers the copay for him. If not, he would probably have to stop his meds.

Not a pretty picture.

HUGS,

Mark

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

Offline allopathicholistic

  • Member
  • Posts: 3,258
Re: Humana 2009 Drug Formulary
« Reply #4 on: December 18, 2008, 02:20:23 AM »
Nor will they tell my what prompted this change. 

I guess they lose money (ie dont make a profit) on Epzicom and so they try to offset the loss on the backs of folks  who need Epzicom to live - that's us pozzies.

Offline edfu

  • Member
  • Posts: 1,084
Re: Humana 2009 Drug Formulary
« Reply #5 on: December 18, 2008, 04:51:19 AM »
Empire Blue Cross/Blue Shield in New York State is changing its RX-benefits administration as of Jan. 1, and Epizicom has been removed from the new formulary.  I strongly suspect that this is the result of all the recent negative research news about the increase in cardiovascular events for those on abacavir (Ziagen), one of Epzicom's two constituent drugs.   It is also due, no doubt, to the removal of Epzicom, because of these research studies,  from the most recommended HAART RX governmental DHHS preferred formularies to a secondary  position.  This is most unfortunate, needless to say, since there is still  considerable controversy and debate about the accuracy of the cardiovascular studies.  Most experienced HIV physicians are not removing their patients from
Epzicom if it has been working and if the patient is not already predisposed to cardiovascular problems. 

http://www.aidsmeds.com/articles/abacavir_heart_smart_2211_15079.shtml

http://www.aidsmeds.com/articles/hiv_guidelines_Prezista_1667_15551.shtml
« Last Edit: December 18, 2008, 05:39:38 AM by edfu »
"No one will ever be free so long as there are pestilences."--Albert Camus, "The Plague"

"Mankind can never be free until the last brick in the last church falls on the head of the last priest."--Voltaire

 


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