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Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: give86gt on January 01, 2015, 06:35:07 pm

Title: Express Scripts and Co-Pay Assistance Cards
Post by: give86gt on January 01, 2015, 06:35:07 pm
I was wondering if anyone that is forced to order though Express Scripts has found success in being able to use their co-pay assistance cards. I'm currently on Truvada and Tivicay.

I was using Curascript last year and was able to use the co-pay assistance cards, but then they told me in December that I was being switched to Accredo, but then when I called them, they said that Truvada and Tivicay are not filled by Accredo. So, they forced me to use Express-Scripts and they are telling me that they do not accept the co-pay assistance cards, so I'll end up paying $70 per month for the drugs.

If they do not accept the cards, does anyone know if it is possible to get reimbursed by these cards directly? It seems like no one at Express-Scripts really wants to help in any way. Any advice would be greatly appreciated. Thanks.
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: ChavinKnight on January 01, 2015, 07:33:58 pm
There are a couple of things that you can do....1) Try having your local pharmacy run a test claim for the drugs.  You may find that you are able to fill your prescriptions for them there.  However, this may come with a catch, namely that you only get a 30-day supply at a time (whereas you might be able to get 90 through mail order), and that you must pay your deductible and then 20% or higher in coinsurance.  That sounds bad, but remember, whatever copay assistance you are getting will offset that amount AND you will be getting credit towards your yearly out-of-pocket maximum AND it will not be coming out of your pocket.

For example--My partner has Express Scripts.  He is taking Stribild.  I filled both of our prescriptions today at a local pharmacy.  He has a $250 deductible and $1,500 maximum out of pocket per year.  After the insurance paid, we were left owing $680 something dollars.  The copay card covered all of that while also meeting his annual deductible and a good portion of his OOP annual responsibility.  Two more fills, and he is done paying anything out of pocket this year.  So, not only is there help paying for prohibitively expensive drugs, there is the added help of that offsetting what would otherwise need to be paid for office visits and blood tests, etc.

Our experience has been that you do not have to use mail order for HIV medications if you have Express Scripts, but they will not tell you this, and you will need to find out through your own efforts.  I do not know if this is true for everyone who is covered by Express Scripts, but I can't imagine that it would not be.  Express Scripts has not been sued (yet) over the HIV mail order problem, and my guess is that they are glad to avoid that by quietly allowing people to opt out if they want. 

Tivicay is made by ViiV; I don't know how they handle their copay assistance program.  You will need to crunch the numbers and see what makes sense.  McKesson handles the copay assistance for Gilead; I don't know if they also do this for ViiV.  It would be nice to have all of this information in a central place for reference.  It seems like we all get focused on dealing with figuring out how to pay for whatever regimen we are on individually and are thus (understandably) clueless about how others handle their (different) regimens.

2)  If you MUST use Express Scripts mail order, then it is true that the assholes will not accept your copay assistance cards.  And you are correct, they do not want to help you, only confuse you and make it more difficult for you to stay healthy.  In that case, you do the following:  log on to www.patientrebateonline.com.  That is a McKesson website.  You follow a series of prompts and questions to print out a rebate form.  You will need to provide proof of what you have paid for copay/coinsurance, as well as the prescription number from Express Scripts.  (I have spoken with McKesson on the phone, and I have to tell you, they have all of the prescription numbers in a database.  They know if you did not get any copay assistance for a particular fill.  Creepy, but it is what it is.)  Anyway, you mail in the rebate form that you print out after you answer the questions online along with the receipt and prescription number.  You can do several months at once or do it at the end of the year, or a month at a time, but that is a lot of stamps and envelopes.  It goes to a processing center in Arizona, and you will get your check in a couple of weeks.

One more thing--I don't know what the annual allowed assistance is for either Truvada or for Tivicay.  The Stribild copay assistance program used to allow a certain dollar amount per month and up to 360 pills per year (12 30-day fills or 4 90-day fills).  That changed last summer, (for Stribild--I am not sure about the others) to $6,000 per year, however you choose to use it, e.g., two fills at retail price with no insurance, $100 per month copay, a certain percent coinsurance after deductible, etc.  The point is that you may just find that you have "leftover" funds on your copay card at the end of the year, enough to get you an extra bottle (or two) of Truvada at retail.  Even if you are forced to used mail order, ask your doctor to write you an extra script for a month of medication with at least one (preferably two) refills.  Get that using any leftover copay assistance, if you can.  It is always good to have surplus on hand, since you don't know when your pills will be lost or delayed in the mail, and as you have wisely surmised, Express Scripts will not help you...they will just tell you to go to the pharmacy and pay full price out of your own pocket, which is obviously not an option for you, or probably more than 99.9% of us living with HIV.  Not to mention the fact that if a person has insurance, they should not be required to pay full price out of pocket..... 

Anyway, I hope that this helps you save some money and to be more informed as you figure out your particular situation.  Best of luck to you.

Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: give86gt on January 01, 2015, 11:58:12 pm
Thank you for your help. You're awesome. Hope you had a nice New Year's Day.
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: ChavinKnight on January 03, 2015, 12:41:31 am
You are most welcome.  Please keep us all informed about how things work out for you, including what you did and what progress you made.  So many times these issues get stated, and we never know how they turned out.  The more information that we all have, the better each of us is in terms of accessing care and also being able to help others who may be struggling. 

Take care...
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: zach on January 03, 2015, 03:54:39 am
nothing to add, commenting so i can follow this thread a little easier
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: ColoradoSkiFanatic on January 07, 2015, 10:35:11 am
Thanks for the great information ChavinKnight.  I'm new to all this... just took my very first Stribild tab about 10 minutes ago.  So far no side effects!  But I've already got a healthy dose of Express Scripts incompetence.

I hope no one minds if I vent a little...

I initially had my dr fax in the Express Scripts mail order prescription... seemed like a good idea at the time:  3 mo supply, vastly less expensive than retail Rx, and convenient.  Well, took a week for it just to show up on my account online, and a ship date 2 weeks later.  WTF?  Got a call from them to verify the Dr's name and contact info to verify the script.  Fine.  Then I wait, checking the website periodically.  Meanwhile I'm reading these forums and learning about all the difficulties folks have with ES.  My stress level increases.  No updates online but after a week or so, the ship date pushes out by a couple days, then a couple more.  So I call...

ES:  The ship date pushed out because we need payment info
ME:  I already provided my payment info
ES:  Did you talk to a person or enter it online?
ME:  I entered online
ES:  Oh, that doesn't work, you have to talk to a person.
ME:  Why do you bother allowing people to enter payment info online if it's useless?
ES:  No response
ME:  Why didn't you contact me?
ES:  I see we called you on the Dec 30th, Jan 1st and 3rd and got no response.  Is your phone number: xxxx
ME:  No that's wrong.  You called me on the 27th to verify the prescribing DR, so you must have my correct number in there somewhere
ES:  I'm only looking back as far as the 30th.
ME:  Whatever.  Do you accept Gilead Co-Pay assistance
ES:  No
ME:  Please cancel the order

So I called my dr, they phone in a new script to local specialty pharmacy, and next day I have my meds, and my stress level is greatly reduced.

My only issue is the cost... $2400 for 30 days.  $80/pill.  Good god.  ES price was $1400 for a 90 day supply. 

The high cost actually benefits me... 2 fills and I've satisfied my yearly out of pocket expense for the whole family (me+partner+daughter) yet I haven't actually paid anything since Gilead's co-pay card picked up the entire $2400 cost.  My actual cost was $0. 

After the second fill of Stribild, all our health care expenses are 100% covered by insurance.  That's great for us, but it still rubs me the wrong way to incur a $2400/mo expense when there's an alternative at $466/mo, even if someone else is paying.  (although I'm sure insurance isn't really going to pay $2400/mo... I'll probably never know what they actually pay)

I think one of the major problems with health care in this country is the fact that people with good insurance don't care what anything costs, so they have no incentive to try to control expenses, and costs are driven up as a result.  My experience is a great example of this.

My bottom line is that I will be paying thousands less every year due to my HIV dx... I'm not complaining, but that's just fucked up.  I'm going to take that money and donate it... can anyone recommend charities that assist the uninsured to afford their HIV meds? 
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: mitch777 on January 07, 2015, 07:18:57 pm
Thanks for the post Colorado.

I'm glad you were able to get your meds with less stress AND less cost! I only wish that we all had the option to avoid ES.

Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: ColoradoSkiFanatic on January 07, 2015, 11:04:12 pm
Hey Mitch... we'll see what happens when my deductible is met and the insurance company has to start paying.  I won't be surprised if they then force me to go through ES.  I'll be sure to get the ball rolling on the refill as early as possible just in case there's a problem. 

Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: gorka on November 28, 2018, 04:24:35 pm
hi guys is this stll best strategy to deal with express scripts?
Title: Re: Express Scripts and Co-Pay Assistance Cards
Post by: Irish Eyes on December 07, 2018, 06:31:19 pm
Thanks for the post Colorado.

I'm glad you were able to get your meds with less stress AND less cost! I only wish that we all had the option to avoid ES.

I knew nothing about ES, alls I knew was that I didn't want meds in the mail.

I used weather as an excuse when they tried to get me to enroll.

Fortunately I have a vacation home in Palm Springs (where I now live full time) and was dx in Palm Springs and was using that as my mailing address to keep all doctors/medical stuff in PS and not SD, though home was San Diego.

When Anthem insurance tried to enroll me in Express Script, I called and explained I only go to PS every 2-3 weeks and meds can't be sitting in community mailbox in 120 degrees for weeks on end.

They agreed. Ever since I pick up my meds in same building as my San Diego doctor, I can pick the date to refill prescription and currently worked the system to now have 60+ stock pile.

Anyone ever in Palm Springs area and need a Stribild or 2 HMU :-)

As for deductibles/copays. I've never paid a thing on a regular basis. I believe there was a billing error a few years ago and there was a bill for about $300. I just paid it myself. EVERYTHING has ALWAYS been free.

My current 'issue' is that since I moved to Palm Springs last July I've been on sabbatical, and as I declared to 'Obamacare' that I have zero income they kicked me off insurance and sent me a 'charity' card. idk mediCal/Care. Government is comical.