Copay Assistance Cards -- Don't Forget To Sign Up

[PozLawyer]

I'm sure this has been posted in some form or another, but it is open enrollment season soon and I just wanted to remind folks of the following as deductibles reset in the new calendar year.  Also, those newly diagnosed may not be familiar with the programs.

If you take Genvoya or Stribild, Gilead’s copay assistance program will cover $6,000 in copays with no monthly limit. https://www.gileadadvancingaccess.com/hcp/financial-assistance/copay-support

If you take Descovy or Truvada (as part of a regimen involving a third drug), Gilead will cover $3,600 in copays with no monthly limit.
https://www.gileadadvancingaccess.com/hcp/financial-assistance/copay-support

If you take Triumeq, or if you take Tivicay as part of a regimen involving another drug, ViiV Healthcare will cover $6,000 in copays with no monthly limit.
https://www.mysupportcard.com/

If you take Prezista, its manufacturer Janssen will cover up to $7,500 in copays per year.
https://www.janssencarepath.com/sites/www.janssencarepath.com/files/edurant-intelence-prezista-prezcobix-savings-program-flashcard.pdf

These copay assistance programs are not insurance. They are available only to people with private commercial insurance, and you cannot be covered in whole or in part by any government-funded plan such as Medicare or Medicaid, VA benefits, or military retiree benefits (Tricare).  Federal government employees who are not military, however, CAN participate in the programs.

For more information you can see my blog post (scroll to the bottom) at https://pozlawyer.com/2017/09/21/the-case-for-high-deductible-health-plans-for-hiv-patients/

[Ptrk3]

Thanks for the update, PozLawyer.

Welcome to the forums.  Please continue to use them for ongoing support, guidance, and education.  Please continue, also, to share your valuable insights, professional training, and personal experience with forum members.

You have much to offer.

Yes, information about copay-assistance cards has been posted on these forums from time to time, but it's always good to post again in order to remind newbies and those others who may not know of their existence, how very valuable they can be.

It is important to note that the copay assistance cards are not "means tested."  They are available to anyone on the identified antiretroviral, regardless of income or network (assets).

For those who take Atripla, here's an additional copay-assistance link (in addition to the Gilead link provided by PozLawyer).  If you're on Atripla, you can apply for both and use them both (not at the same time, but if the yearly amount of one runs out on one, you can then access the other.  This probably won't happen to most, but may apply to some):

http://www.atripla.com/atripla-cost/copay-assistance


Also, here's a link to a POZ summary of various copay assistance and other assistance that may be available (depending on an individual's circumstance):

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

[PozLawyer]

Excellent point regarding means testing.  In fact, it's almost the opposite!  If you are any kind of government funded health insurance due to means testing, you are ineligible.

I left off Atripla because it is now an "alternative" regimen in the DHHS guidelines rather than "recommended", but I failed to take into account that not everybody on this forum is in the USA, and in many countries, Atripla is still the first line of treatment.

[AND IT WORKS! The only reason it is "alternative" is because, despite the fact that it works just as well, some people are bothered by certain side effects (sleepiness being a big one)].  And the guidelines specifically state: "However, an Alternative regimen may be the preferred regimen for some patients."

The current DHHS guidelines are here (note that they refer to the generic names of the medicines not the branded ones, and so may be a little difficult to decipher): https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/11/what-to-start

[Ptrk3]

Though it is true that Atripla is no longer "first line" treatment per DHHS guidelines, in practice that seems to mean for those newly diagnosed (or those who experience problems with Atripla). 

I don't believe there was any recommendation for those currently on Atripla to move to another antiretroviral regimen, as long as things are going well: there was not a recommendation that Atripla be "removed" from use or withdrawn from the market.

Atripla remains an effective and viable antiretroviral medication (I write this not to contradict you, but to reassure people who are currently on Atripla and plan to remain on Atripla).

Many in the United States (including me and several other forum members)
remain on Atripla.  I have no plans to change until/unless a physical or other problem presents itself (i.e., if it "ain't" broke, why fix it?).

For those who begin a retroviral regimen today, or for those who have Atripla side effects or who prefer a "first line" recommendation of an antiretroviral, an informed decision to seek an alternative to Atripla can be made.

It's certainly a testament to a great medical achievement--possibly the finest single medical achievement of the last thirty years--that so many options to successfully treat what was once a universally fatal disease have been developed and that one can make nuanced decisions of the treatment options available.

[PozLawyer]

Though it is true that Atripla is no longer "first line" treatment per DHHS guidelines, in practice that seems to mean for those newly diagnosed (or those who experience problems with Atripla). 

I don't believe there was any recommendation for those currently on Atripla to move to another antiretroviral regimen, as long as things are going well: there was not a recommendation that Atripla be "removed" from use or withdrawn from the market.

Atripla remains an effective and viable antiretroviral medication (I write this not to contradict you, but to reassure people who are currently on Atripla and plan to remain on Atripla).

Many in the United States (including me and several other forum members)
remain on Atripla.  I have no plans to change until/unless a physical or other problem presents itself (i.e., if it "ain't" broke, why fix it?).

For those who begin a retroviral regimen today, or for those who have Atripla side effects or who prefer a "first line" recommendation of an antiretroviral, an informed decision to seek an alternative to Atripla can be made.

It's certainly a testament to a great medical achievement--possibly the finest single medical achievement of the last thirty years--that so many options to successfully treat what was once a universally fatal disease have been developed and that one can make nuanced decisions of the treatment options available.

You are correct in every respect.  There has been no recommendation by DHHS to switch patients off of Atripla if it is a regimen that works for them.  It is one of the most effective drugs out there, and many people tolerate (or even enjoy) the side effects just fine.

I started on Atripla in 2014, but I was one of those people who did not appreciate the side effects, and so I made a switch.  But it got me to undetectable very quickly, where I have stayed ever since.

[OneTampa]

Thanks for this information!

Wonder if people can still sign up for the Co-Pay Cards if they have individual insurance through the Marketplace and the premiums are subsidized due to limited income?

Thank again!

OT

[PozLawyer]

As long as it’s not Medicaid, exchange plans from the marketplace (Obamacare) DO qualify. I’m on my phone but there’s a link to the OPM statement saying they qualify on my blog. I also know from personal experience for a few months when I was on an exchange plan (Obamacare).

I’ve heard from some people that their plans are putting in language that makes copay cards not count when you fill from the carriers specialty pharmacy. See if you can get at least one fill at retail for your January fill because that should keep you good as far as your deductible goes. When you fill at your carrier’a specialty pharmacy, they know whether you used copay assistance or not and could decide not to count it. At retail, all they know is the patient responsibility and then the pharmacy takes care of processing the copay card. So it should count. This is untested, and it’s also the first year I’ve seen plan language like this trying to limit use of copay cards to meet the deductible.

As always read the full plan planuage. Nobody does this but Those of us on this forum at least need to do this every year to watch for changes like this.

[OneTampa]

As long as it’s not Medicaid, exchange plans from the marketplace (Obamacare) DO qualify. I’m on my phone but there’s a link to the OPM statement saying they qualify on my blog. I also know from personal experience for a few months when I was on an exchange plan (Obamacare).

I’ve heard from some people that their plans are putting in language that makes copay cards not count when you fill from the carriers specialty pharmacy. See if you can get at least one fill at retail for your January fill because that should keep you good as far as your deductible goes. When you fill at your carrier’a specialty pharmacy, they know whether you used copay assistance or not and could decide not to count it. At retail, all they know is the patient responsibility and then the pharmacy takes care of processing the copay card. So it should count. This is untested, and it’s also the first year I’ve seen plan language like this trying to limit use of copay cards to meet the deductible.

As always read the full plan planuage. Nobody does this but Those of us on this forum at least need to do this every year to watch for changes like this.

Thanks so much!

Take care,

OT

[PozLawyer]

Thanks so much!

Take care,

OT

No problem. And i forgot to mention mine was subsidized when I was on the exchange plan. The subsidy does not disqualify you.