POZ Community Forums
Main Forums => Living With HIV => Topic started by: koi1 on February 27, 2007, 08:44:18 pm
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I filled my prescription of Atripla yesterday. I was under the impression that Atripla is more expensive. However, it comes out way cheaper for me to be on this regimen than the separate truvada sustiva combo.
Before: 30 day suply of Sustiva and Truvada at ten dollars each=20 bucks.
Now: A 90 day supply of Atripla is 10 bucks. How weird is that?
That is roughly 3.3333 bucks a month.
So, I cannot understand why Atripla is not covered by some insurance plans, but the more expensive separate purchase is.
Anyway, does anyone have any insight?
rob
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Hey Rob,
It's a good question and one I'm sure to be asking soon. My top choice is Atripla followed with Truvada/ Sustiva. I will check with my own pharmacy about it so PM me and I'll let ya know the info I learn.
Good luck!
Wesley
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What is also strange is that my doc wanted to get me on Atripla a month ago, but I asked to stay on the sustiva truvada combo for another month.
I suppose for my HMO it could be an adherance thing, which could save them money in the long run, if they keep patients healthy longer.
rob
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rob, for a 30 day supply of Atripla in Ohio it's $1301.61
Sustiva for 30 days is $474.19
Truvada for 30 days is $831.42 which totals for the both to $1305.61 a four dollars difference if you buy Atripla.
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Yeah,
Rapid Rod, but what I was wondering is why it costs me so much less to be on atripla as far as insurance co-pays are concerned and why some insurances will not cover atripla (aupoint's case).
Rob
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because your lucky!!!
be glad... i pay 2300 a month for my meds until i reach the magic 4000 dollar out of pocket...
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hi everyone, I'm new to the forums. I'm actually at work right now. I work for a South Fl, health dept (giving HIV tests). For the longest this site was blocked so I didn't get a chance to go on before.
I have worked as a pharmacy tech before and all I can tell you is that when medicines first come out it takes a while before the insurance company will put them in their formulary (list of ok'd meds). This happens for all medication, not only HIV meds.
It also happens when meds first go from brand to generics. In some cases the insurance company would not pay for the generic since it was so new so that the brand would actually be cheaper since it was just the copay the person was paying.
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The reason for the price difference is the drug coverage portion of your medical insurance.
Most plans have three components covering the drug costs: Generic Drugs, Formulary, and non-formulary.
The generic drugs usually have the lowest co-pays and the non-formulary have the highest. The formulary is a list of drugs the plan prefers it's subscribers used. The list are normally drugs that have been will address the medical condition for which it is prescribed. Not all drugs are on the formulary for various reason including alternatives providing the same efficacy, etc.
Sustiva and Truvada would be two different pills so the pharmacy is going to charge you two copays. Since Atripla is a single pill, it's only requires one co-pay. The actual cost of the meds is the responsibility of the insurance company so you're not exposed to the "real" cost.
Hope that explains it.
Tom
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Sorry that you have to pay so much Lis. I wish we all had good healthcare. You are right I am lucky. That is why I now have nightmares about losing my job. I am very lucky that I can get meds for three months for ten dollars. It is bullshit that we all can't hav this.
rob
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Sorry that you have to pay so much Lis. I wish we all had good healthcare. You are right I am lucky. That is why I now have nightmares about losing my job. I am very lucky that I can get meds for three months for ten dollars. It is bullshit that we all can't hav this.
rob
Hey Rob,
Well the pharmacy now has my prescriptions for Sustiva and Truvada filled. Shockingly, both are covered with a $10 copay. I forget the exact price, but Truvada was close to $1000 and Sustiva was $600 so I ain't gona bitch.
My total monthly copay is $20. I used a new CVS pharmacy that had a $30 in store gift card for any new or transferred RX so I guess I've actually made $10.
Mail order might be an option later for cost savings. I'll consider that later, not right now as I get ready to start.
Atripla has a program to assist in payment if you can't afford it. I don't know how the program works exactly, but might be an option for some.
I believe Atripla is covered under my insurance also; don't know what the copay is, but it shouldn't be considered non formulary or not covered by insurance companies because with HIV some people can't take one thing or another due to resistance/tolerance/adherence etc. If you are denied ANY HIV drug by your insurance (other than non FDA approved) I would suggest filing an immediate appeal and complaint. Be sure to CC the Insurance Commission. Formularys are BS in this situation. Some drugs don't have generics. Also, there may be valid reasons that other meds can't be taken and it's unfair to charge a Non Formulary or exhorbent co payment.
Mail order programs are generally quite good, but I would be worried with HIV meds. Perhaps someone can suggest a program they like??
Rob, like you I'm absolutely terrified of losing my health insurance. I spoke with doctor about it and so just on the off chance I do he agreed that I should go ahead and file papers at the local health clinic and ADAP stuff so that even though I don't qualify now they would at least have the intake paperwork and other BS out of the way. We have all heard horror stories here of people losing insurance or ADAP.
So, I'm filing the intake crap at all the places and making damn sure I have enough credit left on Amex etc. in case I have to pay for a couple months out of pocket. Grrr!
Right now I'm just thrilled that I only have to pay $20. I don't mind the $26/month increase in premiums now. I'm definitely gona get my moneys worth out of that company. But I'm lucky as well and I feel everyone should be entitled to the same rights
On that I've got to run to pick up my RX. First one!
Wesley
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$10.00 for a 90 day supply of Atripla? wow... I pay 35 for a 30 tablets.
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Yeah Kelly,
I am actually going to save 50 dollars by going on atripla. This is actually the first time I am getting my money's worth for insurance that costs 650 dollars a month. At an average cost of 500 dollars times 12 that is 6,000. Take that and multiply it by the ten years that I have worked for this district, and you have 60,000 dollars that has been paid to this insurance. We have almost gone on strike twice to protect our benefits.
Wes, you will be fine on this combo, unless you are a severe depressive type. I am adjusting alright to the meds, except for the tiredness. But I don't know if this is part of the meds, th virus, or both. I am also craving a lot of chocolate and I love my 7-up with citrus flavor.
Good Luck,
Rob
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Rob,
Did they put Atripla on your formulary? It only came out in July, so they might have just smacked it on there without letting anyone know... I know that Atripla's price is just the price of Sustiva and Truvada combined... it was a rather brilliant decision on the part of the pharmy companies...
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Aupoint,
Well actually aupoint, I don't have to deal with formularies because I am with a "foundation" HMO which is supposedly a not for profit organizaton. They do things a little differently. I don't go to a regular pharmacy to fill my prescription, but to their own pharmacy. This is the first time I have heard of formularies. My HMO is good, but you always have to advocate for yourself. But I guess that is everywhere.
rob
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Aupoint,
Well actually aupoint, I don't have to deal with formularies because I am with a "foundation" HMO which is supposedly a not for profit organizaton. They do things a little differently. I don't go to a regular pharmacy to fill my prescription, but to their own pharmacy. This is the first time I have heard of formularies. My HMO is good, but you always have to advocate for yourself. But I guess that is everywhere.
rob
Gaah! You're lucky!
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Rob,
Did they put Atripla on your formulary? It only came out in July, so they might have just smacked it on there without letting anyone know... I know that Atripla's price is just the price of Sustiva and Truvada combined... it was a rather brilliant decision on the part of the pharmy companies...
Hey Benj,
I don't know what insurance company you have, but you can appeal to have it added onto a formulary. A doctor could make a convincing arguement that Atripla has to be incorporated due to adhearence problems for mentally handicaped, alergic combos, people with other social or medical issues including multiple other meds etc.
By the way, how did you get your stockpile? Was that a mail order deal or something else?
I have another one of my semi dishonest tips for other meds. I've always told doctors that my tolerence built up and got them to write higher dosages. I don't know if you could pull this with HIV meds or a doc might do it even though it's unethical supposedly.
My example is Klonopin. I get a 3/mo. supply in 1 bottle cause I lied about tolerance. If I submit that to mail order I can get a 9 month supply at once. It's a way to keep your copay costs down and your supply up.
W