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Author Topic: Issues with Atripla Copay Assistance Card :( HELP  (Read 1972 times)

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Offline vaguesbleues

  • Member
  • Posts: 93
Issues with Atripla Copay Assistance Card :( HELP
« on: January 08, 2014, 11:11:46 PM »
I am having some serious issues with the Atripla Copay Assistance Card.  Please bear with me while I go through the details.  If you have any advice on what I might try, please let me know. 

I have insurance through my company where I started working last fall, and I am currently obtaining my Atripla prescription at an area CVS every 90 days.  Last year (2013), my copay for a 3-month supply of Atripla was $1000.00.  I freaked out initially, but after setting up the copay assistance card which covers up to $1200.00 for a 3-month supply (i.e. $400.00 for every month), I had to pay nothing out of pocket for the medications. 

Fast forward to this year, and my copay for a 3-month supply of Atripla is now $1600.84.  Whoa.  So, after using the $1200.00 from the copay assistance card, I should have to pay $400.84 out of pocket every three months.  At least that is how it should work.

Instead, it appears that the copay assistance card isn't doing anything, and instead the entire $1600.84 is being billed through my insurance, with it all coming out of my Flexible Spending Account.  So....I'm still paying the entire copay cost for the medication (albeit in pre-tax dollars).  CVS is telling me that the copay assistance card is going through, but Aetna is telling me that they aren't showing any reduction and it's all being pulled out of my Flexible Spending Account. 

CVS is telling me it's a problem with the Copay Assistance Card and with Aetna automatically pulling money out of the FSA, the Copay Assistance Card is telling me it's a problem with CVS, and Aetna is telling me it's a problem with either CVS or the Copay Assistance Card.  Everyone is pointing the fingers at everyone else, and I'm not only getting screwed, but getting stressed out beyond belief that the copay assistance card doesn't seem to be working at all. 

I have two questions:  (1) Is anyone on here having issues with an insurance/copay assistance card at CVS this year, and (2) do you happen to have any advice for what I might try next?  I'm at a loss for what to do.  I just know I cannot afford to pay all of this on my own, which is why I got the copay assistance card in the first place. 
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

Offline buginme2

  • Member
  • Posts: 2,834
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #1 on: January 09, 2014, 12:00:08 AM »
 Your co pay is $1600?

 That's incredibly crappy  insurance you have.


 Sounds like CVS  is making the error.  Is there another pharmacy you can use, maybe one that specializes with HIV?

Offline vaguesbleues

  • Member
  • Posts: 93
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #2 on: January 09, 2014, 12:21:19 AM »
Sadly, yes.  My insurance is the best that is offered at work, and it only covers 70% of the cost of non-preferred (brand) medications such as Atripla.  And the 70% coverage is only available at CVS.  Otherwise, I only have 50% coverage.  Only lucky thing is that my out of pocket costs are maxed out at 4% of my annual pay.  I'll hit that pretty soon if I am forking out $1600 dollars every three months!
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

Offline emeraldize

  • Member
  • Posts: 3,343
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #3 on: January 09, 2014, 12:45:54 AM »
Nothing ventured, nothing gained. This is what I would do and I have co-pay assistance from three pharmaceutical companies. 

I went to Gilead 's page and copied the bottom portion of this post.  The key word to me is 'under-insured'. I interpret you as under-insured to be diggiThe AtriplaŽ Patient Assistance Program assists eligible HIV patients in the United States who do not have insurance, are underinsured or who otherwise need financial assistance gain coverage for or access to Atripla (efavirenz 600mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg).

To find out if you are eligible for this patient assistance program, call 1-866-290-4767, Monday through Friday between 9:00 a.m. and 8:00 p.m. (Eastern).

- See more at: http://www.gilead.com/responsibility/us-patient-access/atripla%20patient%20access%20program#sthash.P3dNxSpO.dpufng into your pay that much.

Call them and tell them what your situation is. And, I think something is wrong for this to be going into your FSA. And I agree that something may be going wrong at the pharmacy level. You may need to request to speak with someone at a higher level than a service representative when you call the co-pay number.

The AtriplaŽ Patient Assistance Program assists eligible HIV patients in the United States who do not have insurance, are underinsured or who otherwise need financial assistance gain coverage for or access to Atripla (efavirenz 600mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg).

To find out if you are eligible for this patient assistance program, call 1-866-290-4767, Monday through Friday between 9:00 a.m. and 8:00 p.m. (Eastern).

- See more at: http://www.gilead.com/responsibility/us-patient-access/atripla%20patient%20access%20program#sthash.P3dNxSpO.dpuf
« Last Edit: January 09, 2014, 01:00:15 AM by emeraldize »

Offline vaguesbleues

  • Member
  • Posts: 93
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #4 on: January 09, 2014, 08:44:54 AM »
After several hours on the phone and in person with both Aetna, CVS, and the Copay Assistance Card program, I think I have figured out what the issue is.  Basically, the huge copay that I have after my Aetna Insurance is $1600.84.  What SHOULD happen is that they should apply the copay assistance card first, and then bill me for the rest.  This should mean I have to pay $400.84 either out of my health savings account or out of pocket.  Unfortunately, Aetna has the health saving account to automatically pay for the copay.  This happens BEFORE they apply the copay assistance card.  So, I am having Aetna turn OFF the automatic payment out of my health savings account (HSA).

So, here's a word of warning for those who pay for their HIV medications using both private insurance (with an HSA or FSA) and the copay assistance card.  TURN OFF the automatic payment out of the HSA or FSA just to be safe.  This issue didn't seem to be a problem last year, but for whatever reason, it is a problem for me now.  I know it causes a bit more of a hassle to get paid out of the HSA/FSA, but it should ensure that the payments are made in the correct order (i.e. applying the copay assistance card first).

But really....ugghh....makes me wish we didn't have all of this insurance, copay insurance, assistance crap.  I can only imagine what a nightmare this can be for those with more than just a single health issue.  Single payer system, pretty pleeeeeeeeeeease?
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

Offline vaguesbleues

  • Member
  • Posts: 93
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #5 on: February 03, 2014, 06:45:34 PM »
Well, it's been a month since the billing issue between Aetna and the Atripla Copay Assistance program.  I've now visited CVS 6 times, called the copay assistance program twice, the benefit support line at my company 8 times, and Aetna Customer Service 11 times trying to get the autodebit turned OFF and the billing straightened out.  Everyone is pointing fingers at everyone else, and I'm sick of dealing with it.  I filed a formal complaint with the state insurance commissioner and hope they will settle it.  It sucks because I've wasted so much time and effort and still no where closer to having the issue resolved than I was on day #1.  We'll see how it turns out....
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

Offline phildinftlaudy

  • Member
  • Posts: 2,961
  • sweet Ann what you think babe...
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #6 on: February 03, 2014, 07:08:33 PM »
My employer just switched (January 1st) from an Aetna HMO/Open Access insurance plan to Aetna HealthFund. So, my employer puts $750 into a Health Reimbursement Account. I have a separate flex spending account w/ $720 in it.

I am going through the same situation as you. I have the copay assistance card from Gilead, but when I got my January script filled - I was told that I had no copay... So, I "assumed" the copay was paid by the assistance card... NOPE....
Upon checking Aetna's member site, the $65 copay I have was taken out of my HRA... lowering it to $685 available. I talked to an Aetna rep and was told that it has to come out of the HRA until it is exhausted... because they can't charge a third party while the HRA is active. She said I could call the HRA funder (who is not Aetna??) and have the autopay taken off, but I would have to then call before each lab visit, doctor visit, etc. and have it turned on (to avoid being billed) and then would have to call after that activity to have it reactivated. She said that she didn't know if they would do that or not but that I could try...

Seems like a lot of hassle to me.

I have decided to just let the money drain out of my HRA - when it is depleted, I will be responsible for copays -but the copay card can pick it up then... by the time I have my labs in March, doctors visit in April and scripts filled between now and May, I should have exhausted the HRA...

I will then use my FSA for copays, etc - with exception of Atripla copay card... once I hit $2,000 out-of-pocket, I don't pay copays, etc., as that is my max.... So, most I may end up actually coming out of pocket is about $600 (of course, FSA is actually out of pocket - but I don't see it since it comes out of my check bi-weekly and is front loaded w/ whole amount available now)

At any rate, I think the whole HRA and inability to bill Atripla copay assist is a crock of sh*t - but having two siblings that work in insurance industry, I also know that insurance is set up much like a casino - and the house always wins.
September 13, 2008 - diagnosed +
Labs:
Date    CD4    %   VL     Date  CD4  %   VL
10/08  636    35  510   9/09 473  38 2900  12/4/09 Atripla
12/09  540    30    60   
12/10  740    41  <48   
8/11    667    36  <20  
03/12  1,041  42  <20
05/12  1,241  47  <20
08/12   780    37  <20
11/12   549    35  <20
02/12  1,102  42  <20
11/12   549    35  <20

Offline vaguesbleues

  • Member
  • Posts: 93
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #7 on: February 03, 2014, 07:26:19 PM »
Sadly, I agree.  Hope it will be sorted, but just means I'll hit the out of pocket max faster, and Aetna will end up footing more of the bill.  Unfortunately, it is a difference of nearly $600 dollars for me for just a 90-day supply.  Agree, though.  What is the point of having secondary coverage/copay assistance if they don't f*&%ing apply it?!
03/10/2011 - Tested HIV negative
04/26/2011 - Inconclusive WB result
05/19/2011 - Confirmed HIV positive
                    VL < 50, T-Cell 747 (30%)
06/13/2011 - VL 345, T-Cell 841 (30%)
08/23/2011 - VL 50,100, T-Cell 1155 (19%) - CMV
09/18/2011 - Started Atripla!!
11/07/2011 - VL 489, T-Cell 881 (31%)
02/08/2012 - VL Undetectable!!, T-Cell 772 (34%)
08/08/2012 - VL UD, T-Cell 1070 (42%)
11/05/2012 - VL UD, T-Cell 1174 (35%)
03/18/2013 - VL UD, T-Cell 972 (28%)
10/04/2013 - VL UD, T-Cell 1025 (34%)

Offline Jody

  • Member
  • Posts: 1,818
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #8 on: February 28, 2014, 11:06:49 PM »
I pay over 500 dollars monthly for my Cigna insurance which covers doctor visits, labs, hospital and medications.  The pharmaceutical needs is why I had to sign up for Cigna in the first place for the optional rider to cover meds as medications are usually through my union but they only cover 5,000 a year for active employees and 1,500 annually for retirees.

My co-pays are only 20 dollars monthly for my Prezista, Norvir and Isentress but a couple of years ago I believe CVS told me I was still responsible for the 20 dollar co-pays even though I received the co-pay cards.  I was wondering if anyone else was in a similar situation and whether CVS is just blowing me off.  It's 720 bucks a year I could save if they took the copay assistance cards. Or perhaps I am just not eligible.  Thanks for any feedback.

Jody
"Wake up to find out that you are the eyes of the world".
 "Try to discover that you are the song that the morning brings."

Grateful Dead

Offline buginme2

  • Member
  • Posts: 2,834
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #9 on: February 28, 2014, 11:21:53 PM »
I pay over 500 dollars monthly for my Cigna insurance which covers doctor visits, labs, hospital and medications.  The pharmaceutical needs is why I had to sign up for Cigna in the first place for the optional rider to cover meds as medications are usually through my union but they only cover 5,000 a year for active employees and 1,500 annually for retirees.

My co-pays are only 20 dollars monthly for my Prezista, Norvir and Isentress but a couple of years ago I believe CVS told me I was still responsible for the 20 dollar co-pays even though I received the co-pay cards.  I was wondering if anyone else was in a similar situation and whether CVS is just blowing me off.  It's 720 bucks a year I could save if they took the copay assistance cards. Or perhaps I am just not eligible.  Thanks for any feedback.

Jody

They are blowing you off.


Offline ARMANDO

  • Member
  • Posts: 249
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #10 on: March 01, 2014, 07:16:35 AM »
GO through CVS CAREMARK  MAIL ORDER,THEY PROVIDE 90 DAY SUPPLY with the same co -pay and the assistance card takes care of that entirely!!!

Offline Piscean

  • Member
  • Posts: 27
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #11 on: March 01, 2014, 11:33:38 PM »
My experience with UnitedHealthcare is similar, but not nearly as annoying as what OP is experiencing. My co-pay is $60 per month. I am only allowed a 30 day supply of Striblid so I must refill monthly.

Everything seemed to work as it should. I would receive my meds via OptumRx (don't get me started) and not have to make any payment. I am thinking all is good, the co-pay card is working. Fast forward two or three weeks and I go to my mail box and find a check from UHC for $60.

It turns out that OptumRx was reporting to UHC that my co-pay had been paid. UHC assumed I was the one who paid the co-pay and would then cut a check to reimburse me with my FSA funds.

In the end, I am not out anything.  It does drain my FSA quickly. I tried to fix the problem but, like the OP, it turned into an endless game of finger pointing. I have given up and just collect the tax free $60 every month until my account is depleted. Once depleted, everything works as It should.

My take away: co-pay cards do not play well with FSA/HRA accounts.


Offline grr770

  • member
  • Posts: 1
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #12 on: March 11, 2014, 12:34:26 PM »
I haven't had a problem with my Atripla co-pay card but that may be because the funds are not automatically taken from my FSA account with UHC.   We are switching to Blue Cross/Blue Shield effective April 1 which has Atripla as a "Tier 2" drug.   After some discussion with the BCBS rep and their calling the BCBS office they ran a test claim for me and Atripla does come up as a Tier 2 drug making my co-pay only $45.00 monthly after an initial $200.00 member per year co-pay.    If I get into a hassle with the co-pay card I'll simply not use it although It should cover the monthly co-pay without touching my FSA.  I'll find out when I go to get my first Rx in April.

Offline Jody

  • Member
  • Posts: 1,818
Re: Issues with Atripla Copay Assistance Card :( HELP
« Reply #13 on: April 11, 2014, 01:04:55 PM »
Thank you for this post.  CVS has some new staff people and after getting co-pay assistance cards from my doctor last week I brought them in.  I will now pay no co-pay for Prezista and Norvir and just 5 dollars for Isentress.  Previously I was paying 20 dollars for each so I will now save 55 dollars a month.  Thanks to emeraldize and you other good folks for giving me the push to save a few shekels and not be so lazy as my mother used to always say I was-LOL.

Jody :)
"Wake up to find out that you are the eyes of the world".
 "Try to discover that you are the song that the morning brings."

Grateful Dead

 


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