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

Issues with Atripla Copay Assistance Card :( HELP

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vaguesbleues:
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. 

buginme2:
 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?

vaguesbleues:
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!

emeraldize:
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

vaguesbleues:
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?

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