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Author Topic: Atripla now covered??  (Read 2752 times)

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Offline AaronbytheC

  • Member
  • Posts: 116
Atripla now covered??
« on: October 25, 2011, 07:39:46 PM »
Does anyone know if something has changed in the drug classification of Atripla in the USA?    

My Insurance:  
Blue Cross Generic Rx health care plan with a $500 annual deductable, after which it only pays 60% of the medical bills.  
Prescriptions it only covers generic drugs with a $10 copay and has no coverage for brand name drugs.


Last month out of the blue I got a letter in the mail stating they had reviewed my request (that I did not send in) and would now cover my Atripla  :o  I thought this must be a mistake so I called  my doctor and she said, no, she had not sent in a request either.  I called the online pharmacy I use for Atripla asked who paid for my last shipment.  They told me Blue Cross picked up all but a $10 copay and ADAP picked up the $10.   ???

Now one month later, I received my Atripla via UPS today and the online pharmacy called as usual to make sure I got it.  While they had me on the phone I asked if Blue Cross or ADAP had paid for it this time.  After putting me on hold for a few minutes they came back and told me that Blue Cross pick up all but a $10 copay and ADAP pick that up as well...  I asked how that could be since I do not have coverage for it.  The lady told me that every September ADAP requires them to send a request to insurance companies to cover the drug, however they are usually rejected and ADAP keeps covering them.  She had no idea why they ok'd mine.

So what is going on??  Should I call the insurance company or just keep my mouth shut?  Would Blue Cross have any recourse to me if they suddenly figure out Atripla is not a generic drug?  

« Last Edit: October 25, 2011, 07:43:09 PM by AaronbytheC »
04/2012 CD4 721 / 29% / VL UD
02/2011 UNDETECTABLE!
12/2010 CD4 587 / 24% / VL 210
11/2010 Started Atripla
10/2010 CD4 420 / 18% / VL 13,500
09/2010 CD4 541 / 17% / VL 10,500
08/2010 CD4 498 / 18% / VL Not Taken
07/2010 CD4 307 / 18% / VL 9,500
06/2010 Confirmed Poz
03/2010 Infected
06/2009 Neg

Offline boi2kwik4u

  • Member
  • Posts: 14
Re: Atripla now covered??
« Reply #1 on: November 13, 2011, 08:35:00 PM »
This happen to me as well a couple years ago while on Blue Cross.   They wanted to charge me that $500 annual detectable but it was only when I tried to fill Atripla did they do that.  So I called the HIV Clinic here in Omaha and they jumped in and I believe ADAP ended up covering for it, didn't even have a co-pay, I'm still not sure if Blue Cross covered any of it.  I'm pretty lucky as I have yet to pay a dime for my Atripla in 2 years since I been on it, even now w/o insurance... still on ADAP. 

I'd keep your mouth shut :)   I don't think they'd do anything.  Maybe there's exceptions to specific drugs?

Offline AaronbytheC

  • Member
  • Posts: 116
Re: Atripla now covered??
« Reply #2 on: November 14, 2011, 02:38:21 PM »
I'd keep your mouth shut :)  

That's what I'm doing.   ;D

I did pull out the thick packet of papers that came with my insurance plan and did some reading.  There is a statement in it that says they may choose to cover a "non generic" drug if they feel it is life threatening.  They went on to say they could at anytime reverse their decision, however past prescriptions would not be subject.  (Meaning they cannot send me a bill for something they paid for.)

The crappy part of this is what if they pay for a year or so then drop it?  As it stands now my co pay is only $10.  Obviously I can cover that without an issue so would (could) ADAP drop me if they feel I do not need help any longer?
My ASO counselor thinks ADAP will not, I guess time will tell.
04/2012 CD4 721 / 29% / VL UD
02/2011 UNDETECTABLE!
12/2010 CD4 587 / 24% / VL 210
11/2010 Started Atripla
10/2010 CD4 420 / 18% / VL 13,500
09/2010 CD4 541 / 17% / VL 10,500
08/2010 CD4 498 / 18% / VL Not Taken
07/2010 CD4 307 / 18% / VL 9,500
06/2010 Confirmed Poz
03/2010 Infected
06/2009 Neg

 


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