Have insurance and copay assistance from Gilead but Complera still over $500/mo!

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

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Miss Philicia:
An ASO = AIDS Service Organization

Someone already suggested that you go to GMHC since you live in NYC. They have case managers that can assess your situation more thoroughly vis-a-vis your insurance and what New York state programs exist that can fill in the holes. NY has more than just ADAP, there's also AHIP and APIC among others.

http://www.gmhc.org/get-support/stay-healthy/benefits-and-entitlements

If I were you I'd fish around on their web site and figure out when they do "intake" days as I think you have to register officially as a "client" first. You should also obtain, if you don't have it already, your insurance benefit package that lays out exactly what your deductibles are, drug formularies, etc. You should receive one of these from your employer and/or insurer annually. At least this way you'll know if you're obtaining the most assistance that you are qualified for.

ADAP, from what I recall, is approved somewhat quickly but it may be an entire month. Probably more like 3 weeks. However, most places have some way to expedite the first month pending approval, but it needs a case manager to sign off on it.

oksikoko:

--- Quote from: dcity on February 15, 2013, 05:52:51 PM ---I just sent in my ADAP application today.

I called Gilead to speak to them regarding the Patient Assistance Program. They said that they couldn't help me financially in addition to the co-pay assistance program because I still have insurance.

Any insight into how long the ADAP process takes?

--- End quote ---

Hey, dcity. I live in NYC too and in the past month have dealt with Gilead's PAP, ADAP and the insurance thing. Maybe my timeline will help? This stuff is all very complicated, so don't be alarmed if it's overwhelming. It felt like years, but was only a few weeks. I'm sure I drove people here nuts in that period, but I don't have any way to pay for the prescriptions, and I only started in December. It was a little much to already be having a medication crisis. ;)

Let's see:
Previous case manager applied for ADAP in the first week of January.

I ran out of Stribild in the middle of January and Gilead let me in their PAP on a temporary basis - 3 months max or until I got ADAP coverage. The letter specifically says I had from 1/7 until April OR until ADAP. They covered one bottle in toto, and I'm ever grateful.

I was approved for ADAP around the 15th of January, but I didn't find out right away, so panicpanicpanic. ;). It didn't take long, but I didn't fill out the initial paperwork myself. I've since taken more control of my own situation, but I'm still catching up with everything that was done on my behalf. For the record, my old case manager was excellent with paperwork, and I should be more thankful. They and the doctor are crap on bedside manner and made me feel terrible and dependent *all the time*. Enough of that talk. GMHC helped me get a new doctor on Thursday (Wednesday?) who I'll be seeing in about a week.

This may be relevant to you too. I have COBRA eligibility, so the NY Uninsured Care Program (who administer ADAP) enrolled me in the Coordination of Benefits program. So, basically, from next month they pay the premiums for COBRA, and I use my old insurance card for prescriptions. If there's a problem with the insurance, I can use my ADAP card instead, but that shouldn't happen. This means I have to do mail order, unfortunately, which I'm not sure how I'm going to handle, but I have two weeks before panicpanicpanic and an additional week before crisiscrisiscrisis. I hope to take care of this early next week to avoid all that. But all in all, I can't complain.

About GMHC: I'm a client there. It's night and day compared to the people I was sent to by the health department when I tested positive, and I feel like for the first time since 11/20, it's not me against the doctor, me against the social worker, me against the NYC Housing authority, me against the DOL, me against, etc. etc. I don't expect them to solve all of my problems, but I finally feel like someone's in my corner after a long period of not having that. I can't even start listing all the things they've done for me already with the ultimate goal of becoming self-sufficient again and not getting sicker quicker for no reason beyond stress, isolation and lack of stable housing. My point is that I recommend you call and see if you're eligible and interested. Full disclosure: some people really like the place I just ran from. We're all on our own paths here.

You have to do an intake to become a client. Here's the info: http://www.gmhc.org/get-support/get-connected/become-a-client You'll definitely need some proof of HIV status so request that ahead of time if you don't have it on hand.

I don't know how long that takes. I had forgotten, but I was already in their system, I guess as a high-risk negative about a decade ago, go figure. ;) I got to skip the intake this time around.

Good luck!

bmancanfly:
I hope you get you situation sorted out quickly. My dealings with NY ADAP were always very easy with reasonably quick response times. GMHC is great.

It's disheartening that so many doctors write 'scripts seemingly unconcerned about the patients ability to pay. Complera is a new (read expensive) medication that is not any more effective than some older (read cheaper) medications. Aripla is only one of those cheaper options, Viramune is another.

I've noticed that my doctor has been pushing Complera on me and some of my friends even though we are all doing well on our current (cheap) regimens. I would imagine that there is some sort of financial incentive for this, but I'm not sure.

Not to mention the financial strain that the cost of these newer, not necessarily better, medications put of assistance programs.
http://www.businesswire.com/news/home/20110811006642/en/AHF-Gilead%E2%80%99s-Pricing-Complera-Break-Hard-Hit-AIDS

Best of luck in sorting it out.

dcity:
Thank you all so much- I really really appreciate all of your help. Needless to say, processing all of this on my own over the past few months has been fairly overwhelming. My doctor has been very helpful but there is only so much he, himself, can do to help unburden my wallet and my mind. I just filled my script for Atripla on Saturday (to be picked up tomorrow, Monday). Hopefully cost will be LOWER since I will now play the waiting game for my ADAP approval.

I will contact GMHC this week! You have all been insanely helpful.

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