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Author Topic: Sometimes HIV gets in the way  (Read 887 times)

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Offline buginme2

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Sometimes HIV gets in the way
« on: January 03, 2014, 03:28:36 PM »
I was recently offered a new job with a new org.   I'm currently reviewing my options and comparing salaries, retirement, healthcare benefits etc to determine if it's something I should take.

 This morning I called the health insurance company for the new job and asked if Complera  was covered and.what the co pay is and the benefits.  I  was told that they consider Complera a specialty medication that requires pre approval.   If approved it would only be available by mail order and the copay  is $175 a  month.

I currently pay $0  and get my prescription filed by my local pharmacy that knows my name and asks me how I'm doing and makes sure I'm not running low on meds. 

 I'm kinda of pissed  off at how hiv  has interjected itself in this aspect of my life.   While this isn't necessarily a deal breaker it does affect my decision and worries me.   

I didn't even check to see if my doctor was in their network. 

I guess that's a  negotiation point to negotiate a better salary,  but it still pisses  me off
"All I need are some tasty waves, a cool buzz, and I'm fine."

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Offline vertigo

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Re: Sometimes HIV gets in the way
« Reply #1 on: January 03, 2014, 04:16:54 PM »
Are you using taking advantage of Gillead's co-pay assistance program?  Your local pharmacy may be applying the card without you even being aware.  If that's the case, it should be transferable to the mail-order pharmacy, which would take your co-pay back down to $0.

I didn't switch jobs, but had a similar situation where my insurer switched my Isentress refills to their own mail order pharmacy.  They said it was a specialty drug.  Oddly enough I can still get Truvada from a retail pharmacy.

I didn't realize it at the time, but by classifying it as a specialty drug, they actually lowered my co-pay from 20% to 10%.  (I believe a lot of the speciality drugs are horrendously expensive cancer meds and the like.)  In any event, the co-pay assistance transferred from one pharmacy to the next with no problems.

And your meds will be approved.  Your doc may have to do some paperwork, but the insurer will comply.  The bigger issue might well be whether your doc is in their network.

Worrying about access to meds is definitely one of the bigger drags about having a chronic disease.  Just another thing to be managed.
« Last Edit: January 03, 2014, 04:21:21 PM by vertigo »

Offline Dan0

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  • Who's this Felicia and where is she going?
Re: Sometimes HIV gets in the way
« Reply #2 on: January 03, 2014, 06:06:03 PM »
I've been offered a move within my company, too, this last week.  It is terrifying! The idea of packing up everything and moving across 1700 miles away is bad enough but then to have to research a different state for my partner and I, the doctors, the resources available - and what of the civil partnership?  At first it was the "idea" of moving that had me evaluating the offer......now its the medical/legal aspects of it all that's occupying my thoughts. Worst of all - what if I don't like it there!

Then I just got home to 3 degrees, snow, my car is buried and this month's heat bill is in the mail.....and I just left Portland and people were wearing jackets!  That might be the selling point. Well played company....well played.

I really never gave any of this a second thought and was fairly comfortable for the past 11 years with the resources I took for granted. Now....sheesh. How the hec do people do this!?
"You can't fix stupid....but you can numb it with a 2 x 4"

"I have standards! ....but....you'll probably meet them."

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10/2006 Atripla
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Offline Jmarksto

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  • Posts: 387
Re: Sometimes HIV gets in the way
« Reply #3 on: January 03, 2014, 07:55:40 PM »
DanO; I am in Portland, let me know if I can answer any questions that would help you.  I have a great doc that I would highly recommend.

Best,
JM
03/15/12 Negative
06/15/12 Positive
07/11/12 CD4 790          VL 4,000
08/06/12 CD4 816/38%   VL 49,300
08/20/12 Started Complera
11/06/12 CD4   819/41% VL 38
02/11/13 CD4   935/41% VL UD
06/06/13 CD4   816/41% VL UD
10/28/13 CD4 1131/45%  VL 25
02/25/14 CD4   792/37%  VL UD

Offline intaglio

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Re: Sometimes HIV gets in the way
« Reply #4 on: January 04, 2014, 04:14:06 PM »
Are you using taking advantage of Gillead's co-pay assistance program?  Your local pharmacy may be applying the card without you even being aware.  If that's the case, it should be transferable to the mail-order pharmacy, which would take your co-pay back down to $0.

I can speak from experience that ExpressScripts' mail-order pharmacy does not accept co-pay cards. You have to submit a form directly to the pharmaceutical company issuing the card to receive a reimbursement.

Luckily, at this time, ExpressScripts still allows me to have my HIV meds refilled locally.
Reality is frequently inaccurate.

Offline aaware72

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  • Posts: 197
Re: Sometimes HIV gets in the way
« Reply #5 on: January 06, 2014, 09:50:07 AM »
These newer all in one pills under the ACA have this problem.  I have been told that starting in 2015 all insurance companies will be required to cover these drugs as a normal prescription. 

The other work around is to have your doctor prescribe the three drugs by themselves and it's is my understanding that they are required to cover them
« Last Edit: January 06, 2014, 09:59:16 AM by aaware72 »
"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Miss Philicia

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Re: Sometimes HIV gets in the way
« Reply #6 on: January 06, 2014, 10:20:51 AM »
I don't think every drug in the newest all-in-ones are available as single drugs yet. For example Cobicistat, the "enhancer" in Stribild has not ever been approved in the single dose manner as Norvir has been.

edit: In fact FDA Rejects Elvitegravir and Cobicistat as Individual Meds back in April, unless something has changed.
"Iíve slept with enough men to know that Iím not gay"

Offline Miss Philicia

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Re: Sometimes HIV gets in the way
« Reply #7 on: January 06, 2014, 10:32:55 AM »
But getting back to the original issue, yes HIV can "get in the way" -- duh. Congrats on your new job offer, you just need to weigh if they are giving you a significant pay raise over your current situation. There's not much reason to change a job unless you hate it a lot unless the next job makes for a good effective pay increase over and above what next raise you could expect in your current position. All it means is that your new employer is cheap with the health insurance coverage he/she provides through this company -- meaning lower premiums for lower coverage.

The pre-approval I'd probably not worry about, especially since you are already on the medication. $175/month or $2100/year definitely sucks, though I don't know I'd go back into negotiations and say "I have AIDS and deserve more money!" I'd either suck it up with what was offered or keep looking for another job. Either that or the pay they're giving you is +$10,000 more than what you are currently earning and it's not an issue, Mr. Fancy Lawyer. I mean seriously, what kind of numbers are you talking about?
"Iíve slept with enough men to know that Iím not gay"

Offline aaware72

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  • Posts: 197
Re: Sometimes HIV gets in the way
« Reply #8 on: January 06, 2014, 10:59:48 AM »
I don't think every drug in the newest all-in-ones are available as single drugs yet. For example Cobicistat, the "enhancer" in Stribild has not ever been approved in the single dose manner as Norvir has been.

edit: In fact FDA Rejects Elvitegravir and Cobicistat as Individual Meds back in April, unless something has changed.

You are correct about the components of Stirbild not all being available. 

Sorry when I mentioned "doctor prescribe the three drugs by themselves" I was referring to Complera and I do believe that these three drugs( (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)are available by themselves.

"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline Since2005

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  • Posts: 419
Re: Sometimes HIV gets in the way
« Reply #9 on: January 07, 2014, 12:32:43 AM »
First, congrats on getting the offer. Ball is on your court. That's always a good feeling.

I am not sure how comfortable you are to disclose your status at work, but I would not make that a selling point to negotiate my salary. I agree, this can be another aspect of HIV getting in the way, but, that would be part of having HIV. It sucks sometimes, especially when one has to take into consideration of paying/not getting couple thousand extra per year.

Having said that, here are some points as to why I would still consider taking the job offer

# If Salary (mines the added costs on healthcare) is still more than what you currently get paid (Duh)
# After you weigh in the options of non-monetary value meaning you would like your job less now with an anticipation of you liking the new job better in the future.
# Prospects of the new job offer is far better than the current job. In this scenario, you might even consider to not even worry about paying 2K+ a year extra because with new job you can possibly get better offer soon either through this company or from a different one.
# You may feel better (a lot better) knowing that HIV is not holding you back to make your decision in building your career path
# Someone made a very good point earlier on saying that with new insurance reform act, you might get a better deal in very near future even staying in with the same company

All in all, I know it sucks HIV is getting on your/our way, but, I would hope that HIV/reduced salary due to having HIV can not be the only barrier when it comes to making a decision of building career path. This can actually vary from person to person because may be 2k is not big for someone who is making 80k/100k a year with better job prospect verses someone who makes a lot less a year.

I do not want to downplay the situation but this may just be temporary in a sense that you can soon get a better job with better healthcare benefits or may be just take this disadvantage in exchange of other benefits/values.

Well, thanks for sharing as this is something that we can learn to see what others have done in the past in terms of paying extra for switching insurance coverage.

Good luck with whatever decision you may make.

Since




 

 


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