Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

NY Healthcare

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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!!!

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.


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!

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.

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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