Aetna wants $639.92 for my meds

[contagion]

My insurance woes are back. When I started worked in my stupid company I realized, Aetna would not cover Epzicom. So I started taking it's ingredients along with Tivicay.

Now they sent me a mail in Dec saying all my drugs have been moved to Specialty Pharmacy Benefits like many others here. Now with 7 days of Tivicay left, I find out the "benefit" I'm getting is that instead of paying a $50 co-pay I pay a $639.92 co-pay. Somehow in 2015, these geniuses transferred Tivicay (along-with Atripla, Stribild and several brand drugs!) into their brand, non-preferred category for which my stupid plan covers only 75% or something.

Thankfully my VIIV co-pay assistance co-pay card covered the $639.92 I owed this time. But the co-pay assistance card has an annual limit of $6000. I can't understand how this company can do this, that too without sending any kind of information! I'm unable to get any kind of help from them. Any ideas on how to resolve this? I'm even thinking of giving up my group plan and applying for Obamacare before Feb 15.

(I'm not eligible for Adap, Ryan White)

[intaglio]

If you break down the overage ($1.679.94) from what ViiV will pay ($6,000) and your annual cost ($7,679.94) for these drugs, that leaves you forking over an average of $139.92/month. Can you handle this expense?

You would have to add together what you pay out-of-pocket for healthcare through your employer, what other out-of-pocket expenses you have to pay through the year due to the policy you hold and this additional $1,679.94. Then you'd have to find a comparable policy that would actually cost you less overall for it to be worth your while to switch.

Plus, you have to consider that your healthcare providers may not participate in some of the plans offered through the ACA. You could switch to a cheaper plan only to face this "gotcha."

You say you are ineligible for Ryan White. Would you be eligible for ACA subsidy or reimbursement at tax time due to your income? You have to take this into consideration also.

It is always worth exploring your options. Just be aware the cost of one of your meds is only part of the matrix for determining your overall savings.

[contagion]

Thanks for the reply @intaglio. I guess another way to look at it is that the co-pay assistance will cover it for 9 months. I'm hoping to have a new job by then!

But it is worrying trend that insurance carriers are shifting tiers to remove brand name drugs even slightly older mainstream drugs like atripla. You can also read about a lawsuit brought against Aetna about their discriminatory policies on mail order.

http://www.courant.com/business/connecticut-insurance/hc-aetna-lawsuit-consumer-watchdog-20141223-story.html