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Author Topic: Increase co-pay of HIV Meds - Anthem Blue Cross  (Read 3638 times)

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Offline vmarchesin

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  • Posts: 1
Increase co-pay of HIV Meds - Anthem Blue Cross
« on: November 15, 2011, 05:13:07 PM »
I was wondering if anyone may experiencing the same issue I am facing with Anthem Blue Cross in Northern California. I went to refill my medication and all of a sudden my copay for Truvada, Reyataz and Norvir increased from $25 (each/30 day supply) to $150 per medication. I called member services and they stated that this is part of the standard agreement that my employer has with Anthem Blue Cross on the new 4-tier medication plan. According the our HR director no changes have been made to our plans but Anthem Blue Cross states that under the new plan the Pharmacy board has moved all these meds from Tier 2 (brand name $25 copay) to tier 4 (speciality copay - 20 % of the price with a min of $150 copay). It appears to me that the Pharmacy Board of Anthem Blue Cross (I live in California) has decided to increase and move these meds to a higher copay arbitrarily. is there anything that could be done. Could someone let me know if I decide to shop for individual health insurance (for example Kaiser where I used to be a member before switching job), HIV would be a pre-existing condition and I would be denied coverage? Many thanks for your help

Offline madbrain

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Re: Increase co-pay of HIV Meds - Anthem Blue Cross
« Reply #1 on: November 17, 2011, 08:59:54 PM »
I was wondering if anyone may experiencing the same issue I am facing with Anthem Blue Cross in Northern California. I went to refill my medication and all of a sudden my copay for Truvada, Reyataz and Norvir increased from $25 (each/30 day supply) to $150 per medication. I called member services and they stated that this is part of the standard agreement that my employer has with Anthem Blue Cross on the new 4-tier medication plan. According the our HR director no changes have been made to our plans but Anthem Blue Cross states that under the new plan the Pharmacy board has moved all these meds from Tier 2 (brand name $25 copay) to tier 4 (speciality copay - 20 % of the price with a min of $150 copay). It appears to me that the Pharmacy Board of Anthem Blue Cross (I live in California) has decided to increase and move these meds to a higher copay arbitrarily. is there anything that could be done. Could someone let me know if I decide to shop for individual health insurance (for example Kaiser where I used to be a member before switching job), HIV would be a pre-existing condition and I would be denied coverage? Many thanks for your help

Yes, HIV would be a pre-existing condition unfortunately. You won't be able to get individual insurance.

If you qualify based on income, you can get California ADAP, and it will pay over your copay for HIV meds (regardless of whether they are $25 or $150). It is allowed to combine Califofrnia ADAP and medical insurance as long you meet the income limits.

Did Anthem just change the tier for these medications halfway through the year ? That sounds strange.
I would review the benefits information from your employer. See if they describe the different medication tiers, and the different prices for each tier. There should be a list of drugs, and which tiers they belong to.
I don't think they are allowed to change this mid-year.

If I were you and I didn't get a satisfactory answer, I would write my congressman, senator, newspaper, and anybody else who listens. Anthem has been particularly egregious with their rate increases and benefit cuts in California.

 


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