Questions about Gilead Copay Assistance Program

[Scaredandnervous]

Hi All,

Welp, I haven’t posted on here since before I was diagnosed with HIV (hence my anxious username, lol). Here I am, almost 4 years later, and I am back to ask the experts some questions about Gilead’s copayment program.

I currently take Biktarvy and have private health insurance through my employer in California. Luckily, I have my copayments ‘waived’ (as many of you do Im sure) with Gilead’s amazing patient assistance program. I am going to be quitting my job soon and likely will not be able to afford COBRA. This is where my questions come in...

1. Do any of you know if Gilead’s copay card works with a Covered California health plan? I realize on the site they say speficially it only works with ‘commercial insurance’, but Im wondering if the Covered California plans are considered commerical insurance or not.

2. On a separate note, I might have to stock pile my meds using the 90 day mail order pharmacy available on my current health plan. This would require me paying $750 in copayments up front. Do any of you know if Gilead will reimburse the cost for the 90 day mail order supply?

I am of course going to call Gilead about this tomorrow, but I am really stressing out about this right now. Any help or insight would be much appreciated.

Thanks guys!

[Ptrk3]

It's good to call Gilead to get the official response, of course.

In the meantime, it's my experience that Gilead generally means Federally funded insurance that is excluded from co-pay assistance (i.e., Medicare, Medicaid, Tri-Care), so you should be fine with a covered California plan.  But, of course, check since Gilead makes the determination of what is acceptable.  I can't confirm this for certain.

Also, yes, but again check, Gilead does reimburse mail order, but there is special paperwork involved and you will likely, as you appear to know, pay up front (hence, the paper work).  As well, there may be a monthly limit, per the co-pay terms.  Mail order reimbursement is more onerous, but it is (or has been) a policy.  Ask Gilead to send you the required paper forms to apply for mail-order reimbursement, if this is the route you take.

Please let us know how things work out so that other forum members in a similar situation can understand.

[Lamek]

Hi Scaredand nervous?

I hope you are doing well. May I ask you why you are quitting your job? I advise you to keep your job as this will keep you mentally active.

[Expat1]

Contact an ASO  (like Gay and Lesbian Community Center Hollywood) as the ADAP insurance program can pay also $ cutoff in California is something like $50000 yearly.