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Author Topic: Questions about UnitedHealthcare Coverage Approval letter re: Stribild  (Read 449 times)

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Offline luckyguy44

  • member
  • Posts: 1
So, I just started treatment one week ago today. I'm insured with UnitedHealthcare, and they did of course require an authorization, which they got, and my Gilead copay rebate card took my out-of-pocket down to $0 for my first dose of Stribild. Great.

I got a letter yesterday that started with:

"We are pleased to inform you that you prescription for STRIBILD has been approved for coverage up to the plan's supply limit for this medication."

Then this sentence in bold:

"This medication is approved for coverage until 07/09/2019, or until coverage for the medication is no longer available under the benefit plan or until the medication becomes subject to a pharmacy benefit coverage requirement, such as supply limits or notification, whichever occurs first."

I'm not sure how to interpret this. Does this mean they will cut off coverage for me in 5 years, if not earlier? What is an insurance plan supply limit? Or is this just standard "we can only approve this for 5 years before we look at a potential renewal type talk."

Basically, do I need to start figuring out alternative funding in 5 years (assuming I'm still with this company of course)?

Offline JR Gabbard

  • Moderator
  • Member
  • Posts: 257
  • Union Jacks
Hi Lucky!
It just means you won't have to get the prescription reauthorized for 5 years.  The rest is boilerplate.  If you change plans you might have to get it reauthorized, but otherwise you're good.
It goes like this
The fourth, the fifth,
The minor fall, the major lift,
The baffled king composing Hallelujah!

L. Cohen

Offline ARMANDO

  • Member
  • Posts: 249
it just means that you have to get a PA{PRIOR AUTHORIZATION}when they feel it is necessary.IT'S nothing to worry about at all,just pay attention to the coverage dates indicated and before it expires ,call them and tell them that you need to get a new PA for your meds.

 


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