Atripla - Gilead & Bristol Myers Briggs Co pay Cards

[Ibre]

Hello All,

Happy holidays, I hope you're all staying warm and dry in your respective parts of the country/world.

I wanted to ask, did I just get myself in some deep shit in regards to co pay cards? I was originally prescribed Stribild but it cost me 3k a month which I cannot do. I never started it and asked my doc to prescribe something else, and she prescribed Atripla. Atripla costs 3k for a 90 day supply with my insurance. I was luckily approved for a Gilead co pay card for 6k a year, and a Bristol Myers Briggs co pay card for 6.8k a year, covering all 12k of my medication for the year. Am I going to be in deep shit in the future if I lose my insurance and cannot afford my medication because co pay doesn't cover it? I am actually a bit scared that I may have not made the right choice since medications are not usually allowed to be changed during their usage.

I am starting Atripla tonight in 45 minutes. Wish me luck. I will post my viral count when I re confirm with my doctor. From my knowledge I'm around 800k.

Thanks, and I wish you all health.
Ibre

[AusShep]

Glad to see you have it covered. 

But what is your actual insurance policy situation (company, deductible, med deductible, co-pay for HIV meds, lab co-pay, out of pocket maximum)? 

I think the copay cards are only for the US, and the maximum out of pocket limit for all plans is ~6,500 per year.  Do you have another plan you can switch to?  If your employer plan is non-compliant to minimum standards, you should be able to get something better on the health insurance marketplace (healthcare.gov)

[rickyrick]

I have not been paying anything monthly for my 30 pills and all of a sudden in 2015 I get slapped with a 950 bill and I refused to pay,  Bristol Meyers helped me out with the 400 off but they tell me I still need to pay the 550 a month for the co pay.  Are they crazy or what do I do to get that 550 covered?  I cannot afford that, I have Kaiser here in California but have to use my companies RX program at Kroger.  I sent message to my Kaiser doctor to help that I was in danger  of not taking the Medicine. I will try calling the RX office on Monday to find out why all of a sudden I went from no cost to 550 a month.

[ChavinKnight]

You don't say where you are located or what health plan you are covered under.  $3,000 per month for Stribild is full retail price; that sounds like they are not covering it, or your doctor has to complete a prior authorization before she can prescribe it. 

I would not worry about changing regimens at this point; if you need to do that, you can deal with it in the future.  The same can be said about health insurance coverage; none of us knows what we are going to have from year to year.  Just go with what you have right now, and try to be at peace with it.  You have enough to deal with starting a regimen.

I don't know what you mean by approved for a Gilead copay card.  Those cards are for anyone, with or without health insurance, and they are not income based.  You just can't be on Medicare, Medicaid, or any other government funded program.

For all of you who are blessed to have health insurance--KNOW THIS.  Starting in 2015, prescription drug costs MUST be included in the annual out-of-pocket maximum.  For 2015, this is $6,600 for an individual and $13,200 for a family health plan.  Since the amount you are paying for your prescriptions counts towards this, when you use a copay assistance card, you are meeting a portion of that total cost.

IF Stribild is allowed by your plan, you would have $6,000 of its annual cost covered by the copay assistance program (again, assuming that you are not covered by a government-funded plan).  Assuming that you filled the prescriptions before accruing other costs for healthcare, then you could have $6,000 put towards your annual limit of $6,600, leaving you with $600 to pay.  That is still a lot of money for some people; however, there are plans that have annual maximums less than $6,600.

You have to sit down with a pencil and paper and work it all out.  It is all more complicated than it should be, and it would be a great help if we had weekend workshops that people could attend explaining all of this and helping people make the most informed decisions/choices as possible.  Do what you can to make it work for your unique personal health coverage situation.  Knowledge really is power here.

Rickyrick--You don't say what medication you are taking.  For those of you taking Atripla, is there any way of combining help from both Gilead and Bristol-Meyers?  If you can, that would be great.  I would look into this; if we are talking about Atripla here, the copay assistance from Gilead might be a better deal if you have to choose....I don't know if the $6,000 a year is for all Gilead medications, or just Stribild, or if there are different amounts of assistance for different drugs.  If your health plan meets ACA standards, then the $950 per month will end once the out of pocket maximum is reached for the year (capped at $6,600 for 2015 as noted above).

It cannot be emphasized enough that given all of the serious problems people with HIV are facing in getting access to medications in a timely manner (due to mail order issues and hurdles put in place by insurance companies), it is in your interest to do whatever you can to accumulate a stockpile of medication.  My personal opinion is that this should be at least a six-month supply.  That cushion is reassuring if you are actively dealing with this nonsense, and/or if you ever find yourself without insurance coverage for whatever the reason, it gives you time to figure something out without stressing that you will have a treatment interruption.  Obviously, not everyone will be able to accumulate this amount, and clearly, it does not help a person who has failed a regimen and must immediately switch.  It is protection for a person losing a job and/or changing health plans, and will work well in the case of a voluntary switch to a new regimen that is optional, but thought to be better for whatever the reason, i.e, you keep taking the stash while you build up the new one.  Should you not be able to use your surplus, please never throw pills away or flush them down the toilet.  As little as two to four pills could make a difference to a person trying to bridge a potential treatment interruption, and even if that amount is deemed low-risk for viral breakthrough/resistance, it might save a brother or sister from unnecessary stress and angst.  Life is hard enough as it is....

My doctor wanted me to start treatment; he wasn't happy that I was getting a prescription filled and not taking it; I told him that I didn't care if he wrote a prescription that day or a year from then, I still wasn't going to start the treatment until I had what I considered an adequate surplus of pills.  I told him that it was his choice; he could rest assured that I would start treatment when I had enough pills on hand to protect me from this crap that these large PBMs are foisting on patients, or he could not prescribe and I would never go on treatment (and I meant it).  I told him that I would have to be a fool to start this kind of treatment under the conditions we are faced with in this country, and that my mother didn't rear any fools in her house.

Please note--IF we had competent, ethical treatment by these large PBMs, none of this would be necessary.  I realize that this forum is not entirely private, and in some ways, it is excruciatingly public.  With that said, keep your having a stash of pills to yourself; it is no one's business.  I don't have a problem sharing any of this with members of the Forums and members of our community who are trying to navigate their way, but I never talk about it anywhere else, even with family and friends, only with my partner who is in the same leaky boat, and frankly doesn't have the sense, energy, or emotional wherewithal to figure any of this out.  When you change jobs and insurance, your new plan may have the unmitigated gall to ask how many pills you have on hand when they set you up in their specialty pharmacy.  None of their business!  You are not exactly sure, which incidentally is true unless you just counted the pills before you called them (don't do this).  If they press, ask why they are pushing this and then politely ask them if they are trying to deny or delay your treatment.  If they have any sense (that will be a coin toss), that should shut them up.  If they say that they want to be sure that you have your medication, then say to them that it feels (and it should) as though they are trying to deny you treatment for HIV and that the best way for them to be sure that you have your medication is to get you set up and fill the prescription as soon as possible.  You should never be without pills once you start treatment.  You should feel increasingly uncomfortable in proportion to the regular decrease in the number of pills that you have in your possession, which will naturally wax and wane from fill to fill of your prescription. 

What you have on hand is irrelevant. 

ir·rel·e·vant
əˈreləvənt/ adjective not connected with or relevant to something.
synonyms:   beside the point, immaterial, not pertinent, not germane, off the subject, unconnected, unrelated, peripheral, extraneous, inapposite, inapplicable;

You are covered as of the day that your plan starts.  They do not get out of providing coverage to a patient on someone else's dime.  And remember Brothers and Sisters, none of this would be necessary if we had competent, ethical, and fair health coverage for ALL in this country.