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Author Topic: How much do you pay for your hiv medication with or without insurance?  (Read 10708 times)

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Offline juju_114

  • Member
  • Posts: 16
I have been just diagnosed with hiv and I just want to get a feel for how much the medication will cost. I heard hiv meds cost $24,000 a year. Is this how must you guy pay a year? I am 21 and under my dad's plan, so I'm sure he will find out once I start buying the medication the doctor prescribed.

Offline Ptrk3

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Many pharmaceutical companies provide copay assistance cards to those with private insurance (i.e., nongovernmental subsidized insurance).  For instance, I am on Atripla and I have a copay assistance card that covers my share of the copay, so I pay nothing for my antiretroviral medication (other than the insurance premiums, of course).

I'm sure I am far from alone in this.

Once you are placed on an antiretroviral regimen, check to see whether the drug manufacturer offers copay assistance and whether you qualify.

To read more access these links:

https://www.verywell.com/list-of-hiv-drug-co-pay-and-assistance-programs-49310

https://www.poz.com/basics/hiv-basics/drug-assistance-programs

HIV 101 - Basics
HIV 101
You can read more about Transmission and Risks here:
HIV Transmission and Risks
You can read more about Testing here:
HIV Testing
You can read more about Treatment-as-Prevention (TasP) here:
HIV TasP
You can read more about HIV prevention here:
HIV prevention
You can read more about PEP and PrEP here
PEP and PrEP

Offline InRecovery

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  • Posts: 22
I've always been blessed with good insurance, so I only have to pay a $65 co-pay once a month. My city has two service organizations called Positively Living and the Hope Center to tell patients what their options are for paying for meds for those who don't have insurance. Your city probably has organizations like that. They can connect you with a lot of resources. Fortunately, I have never needed help with the cost of meds, but that place has given me a great deal of valuable information over the years. I get the idea you are afraid of your dad's reaction if he finds out. I don't know if buying the meds on your dad's insurance plan would allow him to find out, but it is probably the cheapest option you have. Some people print coupons from the internet, but if you already have insurance, sometimes you aren't allowed to use the coupon.

Offline MitchMiller

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  • Posts: 672
I pay $225/month, sometimes less when the pharmacy runs a sale, without using insurance, buying my medications outside of the USA.

Offline Mightysure

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  • Posts: 449
Not one cent. I use manufacturers co-pay assistance cards and other resources that pay up my insurance deductible, and then my insurance covers at 100%. I've only been poz for 2.5 years and things may change soon.

Offline terrymoore

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  • Posts: 497
Hi juju_114
May we know where yo live, as this number will certainly vary from country to country. In Thailand you can buy generic meds for $350USD/year (Original Edurant + generic Truvada).

Offline joemutt

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  • Posts: 1,167
I pay the equivalent of 175 usd per year/14 dollars and 50 cent per month in Thailand; generic nevirapine + generic lamivudine, my doctor cut the third med 2 years ago, poz since 20 years this month, cd4 1150.

Offline mecch

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  • Posts: 13,455
  • red pill? or blue pill?
juju_114

Very few people in the "developed" world pay the retail price of HIV treatment in their country. Which could be 12ish to 30,000 a year, yes.

So if you are in the USA you will get it through your insurance and pay the deductibles and try to get the copay card to reduce your copay. If you were not insured in the USA, there is a special program ADAP.  US health insurance is a big mess, as you know.

In many countries, there is a national health insurance system, so the population is paying jointly for all the approved treatments for everyone who is sick with anything.  So if you hear someone from Spain or UK say their treatment is "free" it is not - the National Health services are buying the drugs and they are expensive in rich countries. 

Then there are sliding scales for some of the drugs that the pharma companies charge depending on the wealth of the nation.  Then there are generic drugs that about a decade or more ago, were allowed to be produced in India and sold there and in poor countries. 

So you can see Terrymoore's post - he's getting a mix of named and generic drugs in Thailand and not at USA prices.

I don't know if you have discussed this already - how are you going to break this news to your parents if they are the ones controlling your health care?
“From each, according to his ability; to each, according to his need” 1875 K Marx

Offline 3DollarBill

  • Member
  • Posts: 20
I take Odefsey, a "newer" drug, and the non-discounted price seems to be about $2500 (according to the monthly statements my insurer sends me).  If I paid my insurance co-pay the cost would be $50 until I hit the "Medicare Coverage gap" in April, when the co-pay would be almost $500.

It was this unexpected gap (for me, who apparently missed that memo) several years ago which prompted enrollment in Louisiana's AIDS Drug Assistance Program (ADAP), which now covers all co-pays as long as I send them the same 11 page enrollment form every 6 months.  That's a small price to pay.  When ADAP first kicked in I tried to pay the $50 co-pay but this confused matters so greatly I gave up and have been a mooch on the system since. 

At 21 you don't have to worry about Medicare yet (if you live in the USA) so please don't be alarmed by my experience.  As others said in the USA there are still programs to help pay the insanely high costs of meds (as long as one's income is low enough, which applies to most of us).  Other countries have similar programs or, gasp(!), universal health care, so many of us with HIV are able to survive. 

In January, 2015 I didn't get my ADAP enrollment in on time and, combined with a backlog at the state agency, faced a $500 co-pay I couldn't afford.  I found generic Atripla at a pharmacy in India for $150.  I hope you won't need to go that route but I can PM the name of the pharmacy if you need it (for some reason I feel it's not OK to "advertise" it publicly but that's probably wrong).

Have you been able to talk to your family about your HIV status?  For many it's a big hurdle to overcome but if you're on your father's insurance it would probably be a good idea to let him know.  You probably don't want him to find out from an insurance company.  Easy for me to say, I know.  Best of luck to you!
Puteo ergo sum

Offline GSOgymrat

  • Member
  • Posts: 5,122
  • HIV+ since 1993. Relentlessly gay.
Between my employer-based health insurance and copay assistance, I pay zero for Stribild.

Offline skeebo1969

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  • Posts: 5,931



  Knock on wood, my wife and I pay nothing for Genvoya.  Copay assistance card has been a Godsend.  We were paying $400 for a 3 month supply before our doctor offered up that beautiful little card.
I despise the song Love is in the Air, you should too.

Offline OneTampa

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  • Posts: 3,021
  • "Butterflies are free."
Have insurance and co-pay is $60/month for 3 meds.
« Last Edit: July 11, 2017, 09:53:04 am by OneTampa »
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline RobbSC

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  • Posts: 17
I pay $50 for a 90 day supply of Atripla.

Offline JosephP

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  • Posts: 318
  • Keep looking FORWARD... Dx'd 8/10/2013...
 :) I used to pay $100 for three month supply... Then drug became 'non-preferred' with insurance co. and my copay shot to $500 monthly... But my Dr. gave me this beautiful little card and I pay zero USD for my Genvoya!! By the way, did you disclose to your family? If you are in the USA, the HIIPA rules wont allow the companies/doctor to disclose anything unless you authorize it (you are over the magical number of 18! ;)
« Last Edit: July 21, 2017, 11:43:45 pm by JosephP »
Today January 20, 2020, I have taken 2378 pills of my ARV since first pill. This means 79 bottles of 30 pills of ARVs at an average of $3950 per bottle or $313,103 USD for my treatment. I have a compliance of 99.83% taking my meds and only .17% (or 4 pills) non-compliant. Of these four pills two I forgot completely, One I lost and one I didn't have with me while traveling! I became UD 3 months after treatment start   ***We are all dealing with this. And we will live long and productive lives!! AND, yes the Lord is my shepherd. Life is good... And thanks for the meds! ***

Offline xunil

  • Member
  • Posts: 98
I have a high deductible plan ($2600 deductible) through my employer and the prescription co-pay cards that the drug companies provide pays that entire amount, and my $35 monthly co-pay.  So I'm very fortunate that I don't pay anything for my medication.
Diagnosed April 2015
First labs and specialist visit April 2015
Initial appt and labs: CD4 560 and VL 18,000
Started Triumeq June 2015
VL UD after 30 days on Triumeq, CD4 slowly rising.

Offline shizukav2

  • Member
  • Posts: 19
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #15 on: August 05, 2017, 03:47:58 am »
I have insurance - and my med's are 100% covered by it.

This is in Bangkok, Thailand at one of the major private (and excellent Hospitals) vs Thai Red Cross

My doctor advised I could try Atripla or go with Teevir which is an identical but cheaper Indian made version. I chose Teevir as there is really no need even 100% covered to pay more for the 'brand'.... and the Doctor was completely open about the option to have any prescription filled by the Thai Red Cross.


Here's the costs of Teevir, which is identical to Atripla :-

Bumrungrad Hospital :- One month supply (30 pills) of Teevir (which is the Indian made identical version of Atripla) is 2800 baht = 84 US$. This can be viewed as the 'full' price... covered by my insurance.

Red Cross Bangkok :- for the same 30 pill bottle, price is i'm led to understand around 1100 baht = $33.... and NOTE my doctor was entirely open to the option of purchasing the drugs from the Red Cross - in my case, i'm covered by insurance so not needed.

A quick google shows Atripla in the USA being >$2500 for a month... which is ridiculous.

Have been at undetectable viral load now for a year, no  issues.

Offline kentfrat1783

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  • Posts: 421
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Re: How much do you pay for your hiv medication with or without insurance?
« Reply #16 on: August 05, 2017, 10:03:10 am »
Hi,

I have a $3,000 deductible for the HSA and then once I meet my deductible then in I pay $35 a month for my Atripla.  January and February won't be fun for me but I should probably look into the ADAP programs.  Then again one of my blood tests that I think I'll have to get done every 3-6 months costs $2,000 so would the ADAP program be worth it, in the end? 

I am sure I will need help in the future with my Rx's and right now if I can afford it myself so I don't want to take the opportunity from someone else.  As there are only limited funds for these programs in the USA I want everyone to have a chance to get their pills.  Is that bad of me?

Kenneth
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline kentfrat1783

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  • Instagram: kentfrat1783
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #17 on: August 05, 2017, 10:20:03 am »
Hi,

I forgot my other thought on the insurance/dad side.

I know with the insurance I have I have my partner on my insurance (he is a dependent on the insurance), and I am able to see all of the EOB's (Explanation of Benefits) that come in.  Both mine and his.  I was not able to see the Rx's he was getting until he granted me rights to that part. 

My words of caution.

Your dad should not see what Rx's you are getting but if he see's massive usage of your part of the insurance he might ask questions.  I could see the usage amount go up for my partner but couldn't see why.  (I knew he was positive as he told me so no big surprise).

Is there a reason you don't want to tell you dad?  He might shock you and want to help you.  Then again not all families accept it the best.  I haven't told my co-workers or friends (other than one) as there is no need for them to know.  My parents and sister have been OK with it.   My sister is also an LPN so she kinda assumed what my Dx was just from what I was telling her. 

I am just curious on what my work will say when they see the Rx show up on the Rx list of high usage.  (These type of Rx's have never appeared as usage before).  I am sure they will ask me if that is me.  Doesn't help that I'm second in charge of the insurance plan at work. 

Ever need to talk I'm here.

Kenneth

Just do what is right for you as there are many resources available to you out their.
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline minismom

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  • Quocumque jeceris stabit
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #18 on: September 01, 2017, 06:46:10 pm »
Mini's Triumeq  is  $3,000 / month. We used to pay nothing. Now, beginning in July, we pay $130 for a 3-month supply.

Mum
www.watoto.com
www.MotherBearProject.org
"Whichever way you throw me, i will stand"
"Don't worry about the world coming to an end today...it's already tomorrow in Australia"  Charles Schultz

Offline leatherman

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  • Google and HIV meds are Your Friends
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #19 on: September 01, 2017, 07:05:09 pm »
Now, beginning in July, we pay $130 for a 3-month supply.
ugh! what caused that price change to happen? have you checked for any co-pay assistance?
leatherman (aka Michael)

We were standing all alone
You were leaning in to speak to me
Acting like a mover shaker
Dancing to Madonna then you kissed me
And I think about it all the time
- Darren Hayes, "Chained to You"

Offline kentfrat1783

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Re: How much do you pay for your hiv medication with or without insurance?
« Reply #20 on: September 03, 2017, 08:34:49 pm »
Mini's Triumeq  is  $3,000 / month. We used to pay nothing. Now, beginning in July, we pay $130 for a 3-month supply.

Mum

It isn't fair but the insurance companies routinely change the tier that the medications are in.  They can do this mid year if they want, but us (the ones that bought the insurance) can only change once a year if we are lucky.  Just doesn't seem fair they can change the contract but that is what they have lobbied to do. 

Then again I was shocked when I thought my Rx (Atripla) was going to be a monthly copay of $150 but turned out only to be $35 a month.  If it was going to be the $150 I would of had to of applied to assistance. 

Yes you should check into Rx assistance if you are too. 

Take care,
Kenneth
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline pittman

  • Member
  • Posts: 286
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #21 on: September 07, 2017, 09:05:33 pm »
Mini's Triumeq  is  $3,000 / month. We used to pay nothing. Now, beginning in July, we pay $130 for a 3-month supply.

Mum

There is co-pay assistance.  The only restrictions I can find are:
  • You may not use it if your sole or primary prescription drug benefits are through a government-funded plan or program, such as Medicaid, Medicare, ADAP, a state pharmaceutical assistance plan, TRICARE®, or CHAMPUS.
  • You must be in the U.S., including Puerto Rico
  • it maxes out at $6,000

There is a simple form to fill out (I did it) and your insurance treats what they pay as if you actually did it, so it counts towards your copay, co-insurance, deductible, and maximum out of pocket limit.

Check out this link:
https://www.mysupportcard.com/index.html?cc=triumeq:patientsavings

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #22 on: September 30, 2017, 07:36:38 am »
I'm on Descovy + Tivicay.  My deductible and out of pocket are met, so my out of pocket is $0.  But I looked at the EOB's for the prescriptions and they are expensive, even in network.  Below is in USD.

I don't know what retail price is, but here's how much insurance paid:
Descovy: $1,563.92 -- 30 day supply
Tivicay: $1,532.07 -- 30 day supply
Total: $3095.99/month

Gilead and ViiV copay assistance got my $6,000 deductible to zero in no time though.  It's actually the very first thing I wrote about in my blog.
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline kentfrat1783

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Re: How much do you pay for your hiv medication with or without insurance?
« Reply #23 on: September 30, 2017, 08:20:00 am »
Hi,

My Atripla is $2,575.35 a month and I have a $35 co-pay after my $3,000 deductible is met.  Prior to meeting my deductible I have to pay full cost.

Now I am one of the health insurance administrators where I work and I have been notified that the discount cards are being changed how it works on our insurance (UHC) next year.  You can still use the discount cards but it WILL NOT count towards the deductible like they currently do. 

You may want to check with your insurance with the changes coming next year.

Kenneth
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #24 on: September 30, 2017, 08:45:51 am »
Is your plan self-funded or fully insured?

It sounds like you are moving from a fully integrated deductible to separate pharmacy and medical deductibles?  If you have an HDHP option you may be able to elect that and keep your integrated deductible--I have never heard of an HDHP with separate deductibles, but I could be wrong.

Either way, you should still be able to get your meds for free(ish), but then you will have to meet your medical deductible with cash, right?

My description of the process with an integrated deductible is linked here [note to mods: this link is to original content]:

https://pozlawyer.com/2017/09/21/the-case-for-high-deductible-health-plans-for-hiv-patients/
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline kentfrat1783

  • Member
  • Posts: 421
  • Instagram: kentfrat1783
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #25 on: September 30, 2017, 09:01:56 am »
Our plan is fully insured with only one deductible.  Everything else with the design of the plan is staying the same.

Currently the discount cards are being applied after the insurance is billed.  Starting January 1, the discount cards are being applied prior to the insurance being billed.  This is for any Rx discount card and not just for HIV medication.

I still have yet to be notified of this on the employee side so many are going to be mad. 

The insurance reason...well you agreed to pay the $3,000 deductible so you will pay it and not the discount card.  Nor was it specific to just the plan we have with UHC, as it is supposed to apply to all of the insurance plans. 
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #26 on: September 30, 2017, 09:22:29 am »
They aren't discount cards though, they are COB with primary health insurance.  By their own terms they are secondary to health insurance and not a replacement for health insurance.  I do not understand how your (or any) health insurance company can change that?

If your card is Gilead, check back toward the bottom, second to last bullet, instructions for pharmacist.  It says that if primary coverage exists (which is required in order to use the card), then submit to primary first, take the patient pay amount, and then submit as secondary COB to McKesson.

I'm sure you are correct regarding discount cards, but copay assistance cards from the HIV manufacturers are not technically discount cards.

I have a PDF of my card if you don't have a physical or electronic copy of your card anymore -- I can send it to you if you PM me so that you can read what I'm describing.
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline kentfrat1783

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  • Posts: 421
  • Instagram: kentfrat1783
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #27 on: September 30, 2017, 09:40:10 am »
All I am saying is just be on the watch for changes coming January 1st.  I have an odd feeling the insurance companies won't tell the customers until they call and wondering why their deductible hasn't went down like it has been in years past. 

And yes I do know what they say on the discount/co-pay cards as I have seen and used them before.

Just wanted to pass along what I have learned to give people the opportunity to ask their insurance companies question and to be able to be well informed consumers. 
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #28 on: September 30, 2017, 09:49:42 am »
100% agree that it is important to stay informed. 

Also I would not be surprised if the fully insured plans are trying somehow to get around the secondary COB copay cards.  After all, once the deductible is met, the insurer is left paying the bill. 

My plan is self funded though so unless my employer decides to screw us over, we should be fine...

But you are right about being informed and I will be reading the SPD closely when it is available, something I also urged everyone to do when I wrote the article describing how the secondary COB copay cards work. 

Thank you for urging people to stay informed!
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline bocker3

  • Member
  • Posts: 4,285
  • You gotta enjoy life......
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #29 on: September 30, 2017, 10:10:50 am »
Hi,

My Atripla is $2,575.35 a month and I have a $35 co-pay after my $3,000 deductible is met.  Prior to meeting my deductible I have to pay full cost.

Now I am one of the health insurance administrators where I work and I have been notified that the discount cards are being changed how it works on our insurance (UHC) next year.  You can still use the discount cards but it WILL NOT count towards the deductible like they currently do. 

You may want to check with your insurance with the changes coming next year.

Kenneth

I get my meds through a mail order pharmacy -- I pay my co-pay upfront and then submit to McKesson for reimbursement through 2 different programs.  This way, my copay still hits my deductible amount and I still get my copay covered, although, I do have to pay it upfront.  Plus -- I get reward points on my credit card!

Mike

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #30 on: September 30, 2017, 10:12:36 am »
I get my meds through a mail order pharmacy -- I pay my co-pay upfront and then submit to McKesson for reimbursement through 2 different programs.  This way, my copay still hits my deductible amount and I still get my copay covered, although, I do have to pay it upfront.  Plus -- I get reward points on my credit card!

Mike

Nice tip on the credit card points.  Never thought of that!
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline bufguy

  • Member
  • Posts: 214
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #31 on: October 04, 2017, 02:03:55 pm »
I have great insurance and I pay $15 for a 90 day supply of my Atripla delivered every 90 days through expresscripts. My doc writes a 90 day prescription refillable 3 times.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .
11/29/18 vl un CD4 1080/39% CD8  .86

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #32 on: October 04, 2017, 02:06:34 pm »
I have great insurance and I pay $15 for a 90 day supply of my Atripla delivered every 90 days through expresscripts. My doc writes a 90 day prescription refillable 3 times.

I am so wary of mail order pharmacies, although I am beginning to lighten up.  Expresscripts in particular, one time when I was on Truvada + Isentress, they delivered the Isentress but not the Truvada.  I just had to go completely off meds for 4 days while they fixed it.
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline CaveyUK

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  • Posts: 1,642
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #33 on: October 04, 2017, 03:46:24 pm »
Thankfully due to the NHS, I don't pay anything for my meds.

Pay a fortune in taxes/NI of course, I certainly feel I'm getting my moneys worth if nothing else ;)
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Offline bocker3

  • Member
  • Posts: 4,285
  • You gotta enjoy life......
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #34 on: October 04, 2017, 04:36:12 pm »
I am so wary of mail order pharmacies, although I am beginning to lighten up.  Expresscripts in particular, one time when I was on Truvada + Isentress, they delivered the Isentress but not the Truvada.  I just had to go completely off meds for 4 days while they fixed it.
I like the convenience of having my meds delivered to my house -- but it comes with the risk of a delay and an error can extend that delay, as you experienced.  It's why I always order my refills the minute I am allowed -- sometimes that has been a month "early", other times it's been 7-10 days (depends on plan rules).  I had built up a 6+ month supply to allow me peace of mind for delivery issues -- or job loss (of course, I always rotated and used the oldest meds first).
I just switched from Atripla to Sustiva/Descovy, so I need to build up another reserve.  I started it by filling my new Rx but not actually switching to it for 4 weeks.  Plus, my new plan allows me to refill a month early, so I'll have a nice reserve in no time.

As for cost -- $60 for 90 days of Sustiva, $90 for 90 days of Descovy, $60 for 90 days of Reyataz and $60 for 90 days of Norvir.  So, $270 our of pocket every 90 days.  I get all the co-pays back, except the Norvir, from the Co-pays assistance cards.

Mike

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #35 on: October 04, 2017, 05:12:27 pm »
I like the convenience of having my meds delivered to my house -- but it comes with the risk of a delay and an error can extend that delay, as you experienced.  It's why I always order my refills the minute I am allowed -- sometimes that has been a month "early", other times it's been 7-10 days (depends on plan rules).  I had built up a 6+ month supply to allow me peace of mind for delivery issues -- or job loss (of course, I always rotated and used the oldest meds first).
I just switched from Atripla to Sustiva/Descovy, so I need to build up another reserve.  I started it by filling my new Rx but not actually switching to it for 4 weeks.  Plus, my new plan allows me to refill a month early, so I'll have a nice reserve in no time.

As for cost -- $60 for 90 days of Sustiva, $90 for 90 days of Descovy, $60 for 90 days of Reyataz and $60 for 90 days of Norvir.  So, $270 our of pocket every 90 days.  I get all the co-pays back, except the Norvir, from the Co-pays assistance cards.

Mike

I'm less opposed to the mail orders than I have been in the past, although I still hold a grudge against expresscripts. My ID doc is affiliated with one of the major hospitals where I live, and their in-hospital pharmacy also does mail order for the really specialty stuff (cancer, HIV, etc.).  He tried to convince me for months to try it and I said no (mostly because I like my Kroger fuel points!).  But then he also explained that any tie there's a prior auth issue, it's their hospital pharmacy staff that sorts it all out with the health insurance, even if I fill the script elsewhere.

So, sufficiently guilt tripped, I went ahead and gave it a shot.  It's been about 6 months now with Descovy + Tivicay mail order, and so far it's gone without a hitch.

Unlike expresscripts, I can call the day before I want a refill, and as long as it's before about 3pm, they'll UPS it for next day delivery.

And like you said (and as I explained in my inaugural blog post), the copay assistance combined with having met my deductible and max out of pocket means I pay $0.

I would still be wary about any mail order pharmacy that I haven't done business with, but I'm satisfied with this one so far.

And also like you, I like to build up a supply!  I actually still have an unopened bottle of triumeq from before I switched to Descovy+Tivicay.  I feel guilty about it, like someone else could use it and maybe can't afford it. :(
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline kentfrat1783

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  • Posts: 421
  • Instagram: kentfrat1783
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #36 on: October 04, 2017, 06:39:41 pm »
I was under the impression with my Insurance company I had to get "specialty" Rx's through mail order, but after I got it filled they sent me a note that due to the type of Rx's (HIV) I can get it filled at my local pharmacy.  I was shocked.

But I've still stayed with mail order.  Just the convenience of them mailing it to me helps.  They do call me each month to re-order and see how I'm doing so it's a nice extra touch.  I could get to the pharmacy but I'm almost order a month in advance on this Rx so like others I'll have a small supply if something should happen.   

All I can think is I hope we don't change Insurance companies next year as I don't want to go through the switch.
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

Offline PozLawyer

  • Member
  • Posts: 59
  • Bipolar HIV+ former DC BigLaw attorney
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #37 on: October 04, 2017, 06:51:42 pm »
I was under the impression with my Insurance company I had to get "specialty" Rx's through mail order, but after I got it filled they sent me a note that due to the type of Rx's (HIV) I can get it filled at my local pharmacy.  I was shocked.

But I've still stayed with mail order.  Just the convenience of them mailing it to me helps.  They do call me each month to re-order and see how I'm doing so it's a nice extra touch.  I could get to the pharmacy but I'm almost order a month in advance on this Rx so like others I'll have a small supply if something should happen.   

All I can think is I hope we don't change Insurance companies next year as I don't want to go through the switch.

Go with what works for you, I always say.  Insurance companies (especially Obamacare exchange plans) faced a huge rash of lawsuits a couple years ago alleging that they were making it too difficult or too expensive to get HIV meds (e.g., only listing Atripla on formulary without prior authorization, even after DHHS moved it to "alternative" regimen; giving unfavorable formulary placement to HIV drugs that represent the current standard of care [e.g., Tivicay, Triumeq, Stribild--all of this even before Descovy or Genvoya]). 

I don't think the mail order issue was part of the lawsuits, but it doesn't surprise me that many insurance plans are now treating HIV with kid gloves and letting patients fill scripts however they choose.  They got spanked pretty hard in that litigation.

And I'm pro Obamacare and I represent a number of health insurers (on entirely unrelated matters).  But it doesn't mean that they always do the right thing from a moral or business standpoint.  And, there is a reason they need lawyers, because sometimes the business people make decisions that get them into hot water!
Follow me on Twitter at @PozLawyer https://twitter.com/PozLawyer.

Diagnosed August 2014
Tivicay + Descovy, VL UD, CD4 fluctuates b/w 400-600
Married, serodiscordant.  Husband is negative.
Avid gamer (Gaymer!).  https://daggr.net/members/3696/

Offline kentfrat1783

  • Member
  • Posts: 421
  • Instagram: kentfrat1783
Re: How much do you pay for your hiv medication with or without insurance?
« Reply #38 on: October 04, 2017, 08:17:06 pm »
That explains a lot. It seemed odd they said I could get it locally as all other specificity Rx's had to be done online/mail-order.  I had an odd hunch there was some type of lawsuit but couldn't find it (then again didn't look much).

I am a fan of the ACA but there are some things that need corrected.  Just like anything new, once it's put into place it needs tweaked. 
Date - CD4 - Percent - VL
08/23/23 - 366 - 26%
06/20/23 - 349 - 21% - UD
04/15/23 - 229 - 19% - <20
11/14/22 - 486 - 24% - 73
10/12/22 - 316 - 19% - <20
06/20/22 - 292 - 21% - <20
01/25/22 - 321 - 22% - <20
09/22/21 - 278 - 19% - <20
02/02/21 - 225 - 19% - <20
06/08/20 - 257 - 20% - <20
03/17/20 - 285 - 19% - 101 (2.00)
12/17/19 - 290 - 20% - <20
09/17/19 - 218 - 16%
06/18/19 - 173 - 16% - <20
03/13/19 - 170 - 16% - <20
January 2019 - Started Triumeq
12/05/08 - 174 - 18% - <20
08/28/18 - 166 - 15% - <20
05/08/18 - 106 - 11% - <20
03/05/18 -   90 - 10% - <20
12/11/17 -   60 -   8%
09/07/17 -   42 -   6% - 54 (1.70)
May 2017 - Started Atripla
05/11/17 -    2 -    1% - 169,969 (5.23)
OI's: PCP
Dx`d May 11, 2017
Location: US

 


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