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

Complera not on preferred drug list

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yogalover:
So I just found out from talking to someone at Accredo that Complera is not on my insurance plans preferred drug list!! WTF...I had called in a refill last week and when it still hadn't been delivered by when they said it was ..I was informed that my dr needed to call with an authorization(which supposedly is a new thing)..so he did that! Still no delivery and then I called tonight and she informed of this atrocity. Its gonna be a long weekend waiting to call BCBS on Monday to find out if this is true. I am freaking out! Has anyone else had this problem happen to them? I hope it is not true...if it is I don't know what to do.

AusShep:
I just checked bcbs Texas Rx coverage list.  Complera is one of the few HIV drugs categorized as non-preferred brand, but it's still covered.  Pre auth is not required.

Can you check bcbs online for your State?

Ann:
Could you get around this by taking the components of Complera (rilpivirine + tenofovir + emtricitabine) in the form of Edurant (rilpivirine) and Truvada (tenofovir + emtricitabine)? Would doing that seriously affect your co-pay?

You'd take it the same exact way as Complera - once a day with food. You'd just be taking two pills instead of one.

I suspect this is the crux of why you're having trouble with it - Complera vs Edurant + Truvada is a convenience issue rather than a efficacy issue, medically speaking. Financially speaking it may be a problem for some if they can't afford an increase in co-pay.


You can read about the various forms of your combo here.

Good luck.

gadawg1979:
I had to go through the hoops and the forms and then they approved it with a higher co-pay... Thank goodness for the co-pay card.
 :o

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