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Author Topic: Why is my Triumeq free?  (Read 1864 times)

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Offline etaoinshrdlu

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Why is my Triumeq free?
« on: September 07, 2015, 03:22:41 AM »
Hello all. Occasional lurker, first time poster.

I had been on Epzicom plus Reyataz for several years. My insurance copay was $100 every 3 months ($50 per drug, 90 day supply). In January this year my doc switched me to Triumeq. When I filled the prescription, the copay was $0! I certainly didn't ask why. This persisted for the refill in April and again in June. The insurance company is Cigna.

In August I changed jobs. My current employer offers only those dreaded high deductible "consumer driven" plans. It's also administered by Cigna; interestingly, my account number there didn't change. When it came time for the August refill, I was expecting to have to pay the $3,000 deductible (90 days of Triumeq is about $6,700). Imagine my surprise when again there was no charge. But what's especially nice is that an imaginary $3,000 has been credited to my deductible, so I'm covered there for the remainder of the year.

Has anyone else seen anything like this before? It's almost like Cigna is automatically applying the value of one of Viiv's copay cards to what I would otherwise have to pay out of pocket. If that's the case, I wonder why they didn't do that with the Epzicom? Or maybe there's something cool about Triumeq that Cigna really likes?

Anyway... just curious about your opinions. I'm certainly not going to ask Cigna, haha.

Offline Jeff G

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Re: Why is my Triumeq free?
« Reply #1 on: September 07, 2015, 08:39:19 AM »
You have probably met your deductible for the year and are now at full coverage .

I am on medicare so I have a copay for a few short months and then catastrophic coverage kicks in once my deductibles have been met and then no more copays that this year, maybe this is why you have no copay this month also. 
HIV 101 - Basics
HIV 101
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HIV Transmission and Risks
You can read more about Testing here:
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You can read more about Treatment-as-Prevention (TasP) here:
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You can read more about HIV prevention here:
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Offline etaoinshrdlu

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Re: Why is my Triumeq free?
« Reply #2 on: September 07, 2015, 02:42:39 PM »
Jeff -- that's not the case. On my previous plan there was no deductible and no co-insurance. It was the older style copay system ($10 for office visit, $25/$35/$50 three tier pharmacy, etc.). On that plan, the Epzicom and Reyataz copays were $50 each, while the Triumeq copay was always $0.

On my current plan, there is a $3000 deductible. The most recent Triumeq refill was my first claim on this plan, so there had been no payments toward the deductible. I was fully expecting to pay $3150 to get the prescription filled -- $3000 deductible plus the $150 coinsurance for name-brand drugs. Indeed, when I log into my Cigna account, I see "Fill date: August 28; plan paid: $3604.54, you paid: $3150.00." But I actually paid nothing. Furthermore, the deductible tracker shows "Amount: $3000. Met: $3000. Remaining: $0."

The only thing I can conclude is that Cigna is actually sending my balances to Viiv's savings card program. That program pays for up to $6000 per year for Tivicay and Triumeq. That's mighty nice of them; certainly not something I'd expect from an insurance company!

Offline Jeff G

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Re: Why is my Triumeq free?
« Reply #3 on: September 07, 2015, 02:52:42 PM »
I see Maybe someone else with private insurance can help Im stumped  :)
HIV 101 - Basics
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You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
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You can read more about PEP and PrEP here
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Offline Seeker

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Re: Why is my Triumeq free?
« Reply #4 on: September 12, 2015, 08:55:40 AM »
Is it possible that when you received this prescription at your doctor's office that you were also enrolled in the viiv healthcare program--this covers the cost of the co-pay when you have private insurance..... Many medications have these sort of loyalty programs that cover the cost.
tested positive Aug 2009
Sept 2009   CD4  198  VL  13,090
started Atripla
Oct 2009    CD4  248  VL  820
Feb 2010    CD4  237  VL  undetectable
Jun 2010    CD4  341  VL  undetectable
Oct 2010    CD4  281  VL  undetectable
Mar 2011    CD4  344  VL  undetectable
Jan 2012    CD4  334  VL  30
Jun 2012    CD4  347  VL  20
Nov 2012   CD 4  349  VL  undetectable
Apr 2013    CD 4  340  VL  undetectable
Oct 2013    CD 4  387  VL  undetectable
Apr 2014    CD4   356  VL  undetectable
Oct 2014    CD4   389  VL  undetectable
Nov 2014   changed to Triumeq
Feb 2015    CD 4  410  VL  undetectable
Aug 2015   CD 4   349  VL  undetectable
Feb 2016    CD 4  399  VL  undetectable

Offline etaoinshrdlu

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Re: Why is my Triumeq free?
« Reply #5 on: September 12, 2015, 04:43:24 PM »
I asked my doc this question, and he said he didn't do any enrollment. When I mentioned that Cigna wasn't charging me anything, his reply was, "Don't ask them why!" Heh.

Offline AusShep

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Re: Why is my Triumeq free?
« Reply #6 on: September 13, 2015, 11:50:41 AM »
I asked my doc this question, and he said he didn't do any enrollment. When I mentioned that Cigna wasn't charging me anything, his reply was, "Don't ask them why!" Heh.

I'm 100% with your doc on this one :)

It doesn't look like the ACA did anything as far as transferring out of pocket expenditures between insurers, but since you're with the same insurance company, it could be done on purpose, or it could be a bug, either way I wouldn't stir the waters...  Since your plan shows your deductible as met, just go with it.

The only thing similar I've had happen is when an employer switched providers mid plan year, so they waived/payed the deductible for everyone as a benefit (they were much lower in those days), but you'd probably know if your new employer did this for you.

Offline scooter24

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Re: Why is my Triumeq free?
« Reply #7 on: October 23, 2015, 07:31:14 PM »
I have Cigna and am on Triumeq as well. However, CVS manages the prescription plan. Is that the same for you?
12/4/13 Tested HIV -
12/2/14 Dx'ed HIV +
12/4/14 CD4 295 29% VL 1356 No resistances
12/19/14 Started Stribild
1/7/15 CD4 338 35% VL UD
2/17/15 CD4 329 35% VL UD
5/15 CD4 444 36% VL UD
7/15 Switched to Triumeq
9/15 CD4 526 40% VL <40
12/15 CD4 534 39% VL <40

Offline scooter24

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Re: Why is my Triumeq free?
« Reply #8 on: October 26, 2015, 08:32:18 PM »
So I did some more research into this and it sounds like exactly what you thought it is. If you're on a high deductible plan and you fill a 90 day prescription for 6K. Whatever the insurance doesn't cover goes towards the deductible and out of pocket max. This sounds quite awesome. It'll take me two fills to hit the out of pocket Mac but then after that, I don't pay anymore for in network healthcare. If I could hug you, I would. You easily saved me $1500.
12/4/13 Tested HIV -
12/2/14 Dx'ed HIV +
12/4/14 CD4 295 29% VL 1356 No resistances
12/19/14 Started Stribild
1/7/15 CD4 338 35% VL UD
2/17/15 CD4 329 35% VL UD
5/15 CD4 444 36% VL UD
7/15 Switched to Triumeq
9/15 CD4 526 40% VL <40
12/15 CD4 534 39% VL <40

Offline etaoinshrdlu

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Re: Why is my Triumeq free?
« Reply #9 on: October 27, 2015, 12:54:27 AM »
I have Cigna and am on Triumeq as well. However, CVS manages the prescription plan. Is that the same for you?
No, my plan requires me to use Cigna's own mail-order pharmacy service.

So I did some more research into this and it sounds like exactly what you thought it is. If you're on a high deductible plan and you fill a 90 day prescription for 6K. Whatever the insurance doesn't cover goes towards the deductible and out of pocket max. This sounds quite awesome. It'll take me two fills to hit the out of pocket Mac but then after that, I don't pay anymore for in network healthcare. If I could hug you, I would. You easily saved me $1500.
Doctors should tell everyone about these prescription cards from the drug companies. Glad I was able to help you save some money.

Offline PittGurl

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  • Posts: 226
Re: Why is my Triumeq free?
« Reply #10 on: October 27, 2015, 11:12:19 AM »
i have a question on this whole drug thing - right now I have state insurance but am looking for a job that will offer healthcare.  As Im considering different positions and companies and accept a job - will they know about my DX and meds? Will the HR Dept be notified that this "new employee" is going to cost alot of money with their healthplan due to medication and dr visits? 
Infected between 5/16/15 - 7/19/15
8-2-15 WB Positive Test Confirmed:  CD4=286 VL=43800
9-3-15 Was supposed to start Triumeq ....got scared :(
9-4-15 Started Triumeq thanks to the people on this board encouraging me :)
9-21-15 labs after 16 days on Triumeq CD4=570; VL 26!!!  HOLY COW it's working!
10-27-15 labs after 7 weeks, 4 days on Triumeq CD4=522; VL=UNDETECTABLE!!!
12-29-15 Started 50 mgs Zoloft for anxiety & panic attacks
1-17-16 decreased Zoloft to 25 mgs - had insomnia, tremor, skin burning sensations
1-28-16 Labs CD4=479; VL=Still undetectable!

Offline AusShep

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  • Posts: 506
Re: Why is my Triumeq free?
« Reply #11 on: October 27, 2015, 01:36:10 PM »
They won't know with any normal insurance plan.

 


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