IPC Copay Assistance Program

[gorka]

keep getting calls from them and they keep leaving messages to make sure I am aware of copay assistance.  They seemed to be hired by the company i work for.   the letter sent did not provide any info on  what happens with my deductible but based on what I found online  for other providers looks like they are then removing deductible amount again so u have to pay full deductible.  anyone have experience with this group? 

[gorka]

just to clarify currently when i pay for meds it is included in the deductible. this program appears that they track how much money you get back from copay assistance and revert back your deductible so u have to pay it.

[gorka]

wanted to provide feedback on this one.  Apperently program is managed by Pillarx.  They make it sound that they are there to help you but basically all they are trying to do is to ensure that money paid by copay card issued by Viiv or Gilead does not count as your out of pocket deductible.  If you were enjoying this perk so far me thinks its coming to an end.  I basically had to give in since i was worried if it would have any implications on my job but wonder if this was OK with HIPA

[kentfrat1783]

Hi,

I'm on an HSA at work so have a high deductible to meet first, but still, a better option than to go with the PPO plan at work. 

This is my first year using a copay card and been having good luck with a twist. 

I am on Triumeq so my program is through Viiv and is a reimbursement and not copay assistance in the way I think of it. Yes, I had to pay $3,035 for my first months fill in 2020, submitted a reimbursement, and got a check about a month later.  I wondered what it would do to my deductible but for insurance purposes, the deductible wasn't changed.     I thought I might as well try and it works. 

Now it is kinda annoying trying to submit the claims every month just to get $35 back but the most I'm out is a little time and a stamp when I mail in the request. 

Many insurances nowadays won't allow you to use the co-pay card as a primary payment but seems like for now the reimbursement thing works well. 

Now I do want to disclose now that I work in HR, benefits management so what you talked about you think "work" emailed the document to you.  Many insurance carries today will contact you to help make sure your care is being cared for correctly.  They don't let the employers know who they contacted or why as that is a HIPPA violation.  I've never heard them contact someone with a copay card so my assumption is they didn't send it to you.  But for me, when I look for assistance I do it on my own and not through a flyer I get in the mail.

If you have to pay for the Rx with an HSA account then it wouldn't hurt to try and get a little assistance for it.  The worst that could happen is your deductible may be adjusted but you would have got paid for the difference so you are net zero. 

I still can't believe the cost of Rx's these days and will continue looking for help on the costs. 

Wishing you the best,
Kenneth

[gorka]

HI Kenneth

Thanks for chiming in. So in my case up until now i would pay for meds myself and get reimbursed via sending receipts like you have.  Since i was paying out of pocket the money i paid was going towards my out of pocket deductible so after 1 prescription I would already be passed 1500 before insurance kicks in.  With this new "assistance"  I have been basically forced to go to pharmacy that accepts co pay cards AND give out my co pay card info (Pillar-x called the new pharmacy and "set it up" for me on my behalf).  so now I dont have to pay anything but i also dont get free perk as before and basically anything co pay card pays, no longer counts anything towards my deductible.  Also the letter came in with my company branding on it so I am assuming it is somehow connected to HR.  Also Pillar-x didnt send me copay card I already had it and  when I asked for assistance with stuff i have not submitted they said they cant help because copay card company refuses to discuss individual copay cards with PIllar-x) so basically I lost nice perk and didnt get any assistance whatsoever and whatever assistance they did with setting up new prescription i could have done myself.  the thing that was troubling they also called my doctor emailed at work and called my previous pharmacy who refused to talk to them. 

[kentfrat1783]

Oh wow,

My insurance won't allow me to go to the pharmacy but do have a letter from them "if getting it through the mail is causing issues I can request to get it via the pharmacy". 

I am still hopeful that the letter didn't come from the company directly.  I know UHC has our letterhead but only used so they know it isn't junk mail.  With HIPPA regulations I'm not allowed to know what Rx goes to what employee but being a small company I can do somewhat a process of elimination on issues.  I can also see the total cost per employee but not the name of any Rx's.  We recently went self-insured so I can see more but after the first month, I only look at the bottom number for the month. 

On a side note, it seems like every few years the insurances are changing things to make it harder for us (and anyone else) getting their Rx's filled. 

Year 1
Insurance carriers - We won't pay that cost. 
Pharmaceutical company - OK we will help pay the initial cost before insurance pays so we can continue to charge a huge price.
 
Year 2
Insurance carriers - First 2 fills allowed at the pharmacy but after that required to do mail order
Pharmaceutical company-OK

Year 3
Insurance carriers - You can no longer use co-pay cards via the pharmacy or mailorder and count towards the deductible 
Pharmaceutical company - OK we will allow you to continue using mail order and understand co-pay cards aren't allowed.  Please send us the invoice and we will reimburse

Year 4 (now)
Insurance carriers - Specialty drugs must be filled at the local pharmacy and co-pay cards are accepted.  Syke, no benefit to the civilian
Pharmaceutical company - Now they are making more money

Didn't CVS and Aetna (I think I have the correct insurer) join a year ago?  Funny have things have changed to benefit the pharmaceutical and insurance companies.

But in reality, I'm sorry you are having issues and my hope is still the letter didn't come from your employer, the insurance company is following HIPPA guidelines and you can get some type of assistance.

This is my first year using the assistance and hopefully, it won't be my last year but who knows.

Kenneth

[MitchMiller]

Kenneth:  Can I ask how much you pay out of pocket for your meds over one year?

I'm asking since my new doc seems to be insistent that I must switch to new (expensive) meds, even though my current meds (generic) work just fine for me.  It is getting difficult to get meds from overseas due to CV-19.  My overseas pharmacy just kept refilling an ancient prescription.  Fortunately I saw this coming and stocked 10 months of meds in advance.

So I may now be forced down a path I really don't want to go because the doc holds the power of the prescription pad.  He wanted me to switch to Juluca which has a GoodRX price of $2800 per month!!!  I told him I would stay on my current regimen that was affordable for me at $175 per month.  He was miffed but powerless to force me to change since I could source my own meds.

I'm on a high deductible ($8K) Obamacare plan.  I'll be on Medicare in 15 months (9/21).

[gorka]

Not answering for Keneth but this will vary greatly on what type of med you are trying to get and what your insurance plan is.  So you should contact them to find out.  Mine tells me how much out of pocket i would have to pay for various meds for 30 day and 90 day supply.  I imagine others are the same

[MitchMiller]

Thanks Gorka. 

Juluca is tier 4 and I am required to pay 50% coinsurance.  My deductible doesn't apply to tier 4 meds, so it is zero.  I have an $8100 out-of-pocket max on my insurance policy.  I go on Medicare Sept 23, 2021. 

So for the one year period 9/23/2020 - 9/22/2021, I would pay at least $8100 (50% of $8100 x 2) since I have not paid much out-of-pocket in 2020.  That translates to about $700 per month.

So I was wondering how payment assistance programs work.  I read the POZ article on patient assistance programs, but it leaves a lot of questions unanswered.  Since Juluca is a tier 4 drug, I'm guessing I would require a program that would pay some or all of my coinsurance up to my $8100 out-of-pocket max.  Reading the sparse information available on the Juluca web site implies I would perhaps be eligible for a "savings" card with a maximum savings per year of $6250.  I went through the process to download a card from the web, but it still doesn't tell me if I will always be reimbursed for my full coinsurance.  I'm guessing I will, but not sure.

Do these programs look at your savings when determining eligibility?  It seems they do not, but why would someone with $3M+ of savings be getting assistance?

If the assistance is based solely on income, is it on a sliding scale where the assistance decreases as the income level increases?

Potentially, how much assistance does one get?  What would a sliding scale look like? 

For example, my Obamacare premium assistance starts around $705/month for an income of 138% of federal poverty level (FPL) and decreases linearly to zero as the income level reached 400% of FPL.  Savings are not considered when determining Obamacare premium assistance.

[MitchMiller]

Gorka

After re-reading this thread, it sounds like the co-pay "savings" card is worthless because it doesn't count toward your max out-of-pocket expenses.  The only benefit would be if you had cashflow issues and couldn't afford to pay so much up front.  However, your overall total annual out-of-pocket expenses would be the same.

Now Kenneth mentioned that he "back doored" the insurance company by foregoing co-pay cards and directly submitted a reimbursement request to the pharmaceutical company.  That way the insurance company is in the dark about what assistance you're getting from the pharmaceutical company.

It seems your insurance company has employed a "detective" (Pillarx) to attempt to determine if you're getting some assistance they don't know about so they can dock it from your expenses put toward your max out-of-pocket.

Gosh... now I know why I order drugs from overseas.  I can order whenever I want, order as much quantity as I want, for reasonable prices, and my pharmacy even runs "sales" at 30% - 50% off sometimes... and it shows up at my door in three weeks... at least until CV-19 hit.

I just got a call from the postal service telling me my long lost package of meds will eventually be delivered.  It has been stuck in the sorting center for nearly two weeks.  They said they just don't have trucks available to ship packages out right now.  It used to take about 3 weeks to receive my meds after I ordered them.  Now it is taking 3 months... but at least I'm hopeful they will arrive... and I already filled the pipe with another order I placed three weeks ago when I noticed my pharmacy is now depleting their stocks of meds with long lead times to replenish.

[Ptrk3]

MitchMiller:  many co-pay cards are not based on net worth, cash flow, or income.  You would have to check what is available for your specific antiretroviral and the pharmaceutical manufacturer of that drug (which would offer the co-pay assistance).

Furthermore, some insurance carriers do, indeed, count that co-pay assistance as if it were your own contribution to your yearly out of pocket (though it's true that some insurance carriers over the past few years are not allowing such assistance to count).  Again, one would need to check with their individual carrier.

In other words, it's a matter of the specific antiretroviral and the insurance carrier, so one size may not fit all.

In my case (Atripla), I find my co-pay assistance card to be extremely valuable.

[MitchMiller]

Thanks Ptrk3.  Fortunately, I've begun receiving all the backlog of medications I had ordered.  I should have a small order arriving tomorrow, and another one in the pipeline.  If it arrives in a couple months, I'll be stocked until the middle of June 2021.

I fear events could spiral out of control here in the US, causing a disruption of flights to this country.  The country where my pharmacy is located, stopped all flights to the US, including cargo, earlier this year.  I suspect they may suspend flights this fall and possibly not resume until after flu season is past in 2021... so I wanted to be fully stocked.  POZ also has an article posted warning of potential HIV medication shortages, including two medications I take that are widely used:  EFV and Abacavir.  Hopefully a CV-19 vaccine will soon be identified and proven.