Genvoya and UHG

[Sprackdoll]

I'm having an issue with my company insurance. They won't cover Genvoya. I had a bad allergic reaction w Truvada and Tivicay, so my doc told me to stop taking them after a week. Now she is giving me Genvoya but it's too new for UHG to cover. They are so hard to deal with. We've tried Gilead to cover but instance has to deny our appeal. They said they will be adding Genvoya to their FDA approved Med sometime in July or August. I was diagnosed in Jan. I have been off meds since March. I have my races coming this month and next. I'm not sure if I have enough endurance and energy to do them. Has anyone have same issue? If so please share what you've done to get meds?

[bmancanfly]

Sorry your having troubles getting your 'script filled.

But there are dozens of other approved meds available that are covered by insurance.  Why the insistence in taking Genvoya only?

Could you clarify what you mean by "allergic reaction"?

[Expat1]

There are a number on different approaches to your problem.

I assume you are in a US state.
States have Insurance Commissions Depts etc.

Document that you disagree with the decision not to give you the medicine. 
Keep copies of all corespondence.  Buy a folder and Xerox everything.
Keep a log.

File an Appeal with the Insurance Company.
Share all information with the State Department that regulates insurance.  Call Daily, or a couple of times a week.  Always ask for names of people you are dealing with.  Include names in all correspondence.  EG, Mr.  Jim Smith at Cinga's claim department told me.........
I sent an Appeal regrading this to Mrs Jones in the Commissioners office...... etc.

Meanwhile the virus isn't waiting for them, it will do what it does.  So you need to get a temporary solution while waiting for the outcome of the appeals.

You could for example go on a non-nuke therapy bypassing the meds you are sensitive too.   Say an integrase inhibitor plus a boosted protese inhibitor.   you could go on  Kaletra+3TC.  Or you could go on darunavir/r monotherapy while waiting for approval. 

A short period of combid plus some 3 drug is also possible.  (I dont recommend for long term but my  friend needed to use it when he developed a kidney reaction to TDF.
He also took d4t for 2 months while the doc sorted out his problems.)

If you are persistent the insurance company will likely eventually give in.  They dont want the continued harassment from the state insurance commissions.  At least that has happened for  me in the past in California. (It was for non HIV related issues.)

[xunil]

Does your insurance know that you've tried another covered treatment that you must discontinue? United Health Care will cover Genvoya, but only if you've tried Triumeq first.  You have to have a reason to discontinue Triumeq and then they will cover Genvoya.

[Peacedj]

I have United Health Care.  They will cover Genvoya if you have tried Triumeq first.  Another option is to have your Doctor prescribe Stribild which is similar to Genvoya.  Stribild is covered without any restrictions with my United plan.

Another piece of information that I stumbled upon about United is that if you call them and say that you are worried about prescription accuracy they will allow you to use a local pharmacy instead of their mail order pharmacy.  Using a local pharmacy allows you to use the various prescription card offers by drug companies to help you reach your out of pocket max without any money coming out of your wallet.  If you use their specialty pharmacy they won't allow it.

I used this technique and now pay $0 for my meds and all covered medical care for the remaining of my benefit year.

[BKKKevin]

^^^ I use UHC mail order pharmacy OptumRx and they take my Gliead copay card an I pay nothing for my meds