Medicare Drug Copay Assistance Programs: Are there any?

[greencarnation]

Planing on retiring next year (age 66) and going on Medicare, of which I know very little. Currently I am on Genvoya and Prezesita, covered by my private employee health insurance. I met recently with a Humana Medicare salesperson and was astounded to learn that both drugs are at the top of the range for copayments (Tier 5) and that my out of pocket expense for both will be over $12,000. per year.
This will be a significant dent in my yearly retirement income.

Does anyone know of any programs that might help cover any or all of the copay costs for a person on Medicare? I am currently on patient assistance programs for both meds that cover all of my copay costs, but Medicare supposedly changes everything with them.

I have read the Federal guidelines for ADAP assistance and it seems I would qualify for that. However, I live in Georgia and the state website for this tells me that I do not. I assume each state is different regarding qualification criteria? Any thoughts or suggestions would be most appreciated.

[Expat1]

Medicare does not allow you to use drug company coupons for copay.
 Some options:

Georgia has Kaiser Medicare Advantage I think.  They put most hiv drugs in lower tiers than the other companies (check the formulary for Georgia.) In California for example Kaiser has it in Tier 3 and the copayment is $47 in the beginning and it reduces to  $12 in final phase of part D.

Move to a state with more liberal ADAP like California where it pays the copayments and coinsurance.  And even the insurance premiums for part D and medigap.

Instead of part D, just get Drug makers Patient Assistance for the meds. 

Check out generic formulations.   (From the drugs you take, I assume that you  have a resistant virus so this may not be an option.)  I checked the generic price of tenoforvir 300mg and lamiduvine300 and at good rx you can get a coupon for 180 pills each for   (a six month supply  for $432.)    You would need additional meds like  generic atazavir which is quoted at around $250 monthly.

Source the meds during a vacation in Thailand.  Genvoya is $90 for a month supply,  and Darunavir  about $200 per month, bring a RX from your Doctor for 1 year supply and obtain at Thai Red Cross.  (Or at double the cost at Pulse Clinic.)  Have a good vacation also.

Buy the meds from one of the Pharmacies in India,   start at the website Iwantprepnow    look around for hiv treatment.   There are several that Brits use for prep that also have hiv treatments.  They wont have the Genvoya, but can you substitute Dolutegravir plus TaferoEM 

I source my generic descovy (Tafero-EM)  at Pulse clinic, as I live in Thailand.   Cost is about $90 per month.

Go to the medicare.gov site,  find part D plan.  There is a place where  you put your drugs in and it compares all the plans in your area,  can list by cheapest yearly drug cost to you.  (Note that you have to select a pharmacy and if you want to compare the medicare advantage progams, make sure you list the Kaiser pharmacy or you wont get its program priced in.)


Hope some of these suggestions are helpful.   I just signed up for medicare Part B, and am returning to the States in a few months as I turn 65, and will live in California.  So I just went over all possible outcomes.  For me it is cheapest to go ahead and get Part D, cheapest plan, but bring all my drugs from Thailand twice a year.  I would prefer not to have ADAP involved in my life.  But it is a fall back option.   That I will investigate once I move back..

The list of Thai Red Cross drug prices is on this site elsewhere. 

Good luck.

[greencarnation]

Many thanks for your detailed and informative suggestions. Several questions here regarding buying HIV meds in Thailand:

1.) Does the Thai Red Cross or the various other clinics that provide them accept credit cards or is this a cash transaction only?

2.) What is the maximum amount that can be purchased at one time and taken out of the country? Hopefully at least a one year supply, two years would be even better.

3.) Is a script from a U.S. physician enough? Can I simply carry it by hand or does it need to be faxed from the U.S.?

Any further information you may have on purchasing meds from India would be much appreciated. Any information on the Indian drug manufacturer CIPLA and how purchases in the U.S. might work?

Thanks again!

[Expat1]

Red Cross I think is Thai Baht (cash) only.
All private hospitals accept visa/mastercard.
The RX might be good at Thai Red Cross.  Look at the other posts on Thai Red Cross.
In your situation you might be better off to buy generics from India. 
Iwantprepnow a British site recommends. 
They will accept your script and no need to travel.
https://www.greencrosspharmacy.online/
Pulse clinic in Thailand will mail.  You will need to send them script via email.  Determine which meds are availiable.

Technically you are permitted a 3 month supply when  you go through us customs.

If  you order from India or Thailand via post, order in 3 month increments.

You could buy at both Thai Red Cross and Pulse.  (Pulse will sell a year supply at a time).  If wanted.

Understand that customs could confiscate the large amount.   (I usually bring in 6 month supply at a time when I go to  USA.  )   Emphasize it is personal use. I always bring a Doctor note.