POZ Community Forums

Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: kentfrat1783 on November 09, 2018, 05:33:06 pm

Title: United Healthcare - No longer covering Atripla
Post by: kentfrat1783 on November 09, 2018, 05:33:06 pm
Hi All,

Well, I haven't been on lately (sorry about that) but my next doctor appointment should be interesting.  I just open the mail and the current United Healthcare insurance I have is discontinuing the coverage of Atripla starting January 1st. 

We have talked a little at the last appointment about changing my Rx's so this has just pushed the change quicker.  I do have 4 bottles bought in advance so that will help with the switch over.

They (UHC) has stated in the letter that there are two different options with a $0 cost but would mean multiple pills other than the single pill I take now. 

Then again, who knows what we are doing with the insurance next year at work if we are staying with the same company or changing.  Got to love change.

Anyone else receive this letter or am I the only lucky one?

Thanks,
Kenneth
Title: Re: United Healthcare - No longer covering Atripla
Post by: bocker3 on November 12, 2018, 10:23:59 pm
could it be that they aren't covering Atripla, but will cover the generic versions of its components?  It would likely cost them less (may or may not cost less for you, depending on the difference in copay for 1 name brand vs. 2 generics).
I had switched from Atripla to Sustiva and Descovy, to get on the newer forumalation of Tenofovir.  I received a message from my insurance saying they would be charging me much more to stay on the generic version of Sustiva, so I switched - saved me half my old copay.

Mike
Title: Re: United Healthcare - No longer covering Atripla
Post by: BKKKevin on November 13, 2018, 05:34:14 am
If you were the one that had to buy the drugs and pay the actual market rate... Would you opt for the much higher cost (by several hundred dollars a month) Atripla or a lower cost 2 pill generic option that has the exact same drug component?...
Title: Re: United Healthcare - No longer covering Atripla
Post by: Brad711 on December 05, 2018, 03:50:15 pm
I am also with UnitedHealthcare and received the same letter. Beginning January 1, 2019 I will have to pay more for Atripla and beginning April 1, 2019 - Atripla will no longer be covered under the pharmacy benefit plan.

They gave me a few choices to switch to. They include the following:
Cimduo, Isentress, Isentress HD, Juluca, Symfi, Symfi LO and Triumeq.

If I switch to either "Cimduo+Isentress" or "Cimduo + Tivicay" they will provide me a $250 pre-paid debit card(Twice a Year) to pay for medical expenses.

The only medication I've been on since diagnosis(2006) has been Atripla and I have pretty much no side effects from it. My current CD4 count is 1128 and HIV-1 undetectable.

After doing some research is sounds like Symfi and Symfi LO are a new generic version of Atripla. So i'm sure UHC is doing this so they can save money in their pocket.

I'm am not familiar with any of the other drugs listed. So if anyone has any recommendations or thoughts let me know. I am considering asking my doctor to switch me to Juluca and been wanting to know from others who have been taking it, if they have been happy with the switch.

Would greatly appreciate any thoughts on switching.
Title: Re: United Healthcare - No longer covering Atripla
Post by: kentfrat1783 on December 05, 2018, 07:05:32 pm
Hi,

I just back from my doctors appointment where we talked about this.  The main specialist did say for me if she would have initially started me on ART's she wouldn't have put me on Atripla but there is nothing wrong with it.  We have actually been talking the past few months transferring me off of it as I'm having some side effects. 

She also said many of the recommendations are good and newer, but I believe that both of them are wanting me to start Triumeq but they need to make sure that I won't have a life threatening side effect to it.  So they are needing to do genetic testing.  If it wasn't Triumeq then it was another T word.  I could only imagine how much the genetic testing is going to cost me.  :(

Have you been able to talk with your doctor about this yet? 

I'm at least lucky enough to have a few months bought up so I can make it through the switch. 

Just stinks you are being forced to switch when what you are taking is working.  It would be different if it wasn't working.

Kenneth

Title: Re: United Healthcare - No longer covering Atripla
Post by: Brad711 on December 05, 2018, 07:49:05 pm
I met with my new doctor here in Florida a few weeks ago and just got all my latest test results which were good. He was suggesting i switch to either "Cimduo+Isentress" or "Cimduo + Tivicay".  But i've been researching Juluca and trying to get feedback from anyone who has switched to Juluca to see how they like it.  From what I have researched it seems Juluca is less toxic to the body since it only is a combination of 2 drugs instead of 3. 

I'll be able to get Atripla thru at least January but will have to make the switch after that sometime.
Title: Re: United Healthcare - No longer covering Atripla
Post by: kentfrat1783 on December 05, 2018, 07:51:08 pm
If my CD4 count was higher they would be inclined to try one of the 2-med pills but with how low my CD4 still is I need the 3-med pill still.
Title: Re: United Healthcare - No longer covering Atripla
Post by: bocker3 on December 05, 2018, 07:53:41 pm
I am also with UnitedHealthcare and received the same letter. Beginning January 1, 2019 I will have to pay more for Atripla and beginning April 1, 2019 - Atripla will no longer be covered under the pharmacy benefit plan.

They gave me a few choices to switch to. They include the following:
Cimduo, Isentress, Isentress HD, Juluca, Symfi, Symfi LO and Triumeq.

I find it rather interesting (in a maddening sort of way) that your insurance company is offering you suggestions of drugs to switch to after they stop covering Atripla.  This is really up to you and your doctor to decide, not them. 
I do not find it all that strange that insurance companies are starting to not cover Atripla any longer, as the 3 drugs in that pill are now all available as generics.  I received a letter from Aetna stating that if I wanted to stay on Atripla I would need to cover my copay PLUS the difference in cost from the generic components.  I have switched to the generic of Sustiva, but also switched to Descovy, so no generic for that.

At any rate -- You should be working with your doctor on what to switch to -- with a copy of your insurance's Rx Formulary, so you understand what is covered and at what cost.  You should NOT be taking the recommendation of the insurance company on what to switch to.

Mike
Title: Re: United Healthcare - No longer covering Atripla
Post by: kentfrat1783 on December 05, 2018, 07:58:52 pm
Hi Mike,

I totally understand where you are coming from.  My doctors and I have been talking about switching for about the past 6 months but this is just speeding up our process. 

This isn't something new but the specialists were a bit irritated the insurance is dictating it but what can we do?  It isn't like I'm a billionaire and could afford it without insurance.

Once I figure out what I'm switching too in January I'll be looking into copay cards.

Thanks,
Kenneth
Title: Re: United Healthcare - No longer covering Atripla
Post by: Brad711 on December 05, 2018, 08:06:07 pm
Trust me Mike... when i got that letter i was like WTF.. 

I took the letter to my doctor about 3 weeks ago to discuss and he went over all the drugs discussed in the letter and gave me his recommendation to think about before the end of the year.

Atripla has been the only drugs i've been taking and since it's been working I really haven't followed any of the newer drugs out there. Thats why I began researching the Juluca they listed in the letter. Actually i've been researching them all but Juluca kind of stood out to me a new options that may be less toxic to my body if I can be able to take it.

Thanks for everyones feedback thou.. =)
Title: Re: United Healthcare - No longer covering Atripla
Post by: bocker3 on December 06, 2018, 06:48:52 am
Trust me Mike... when i got that letter i was like WTF.. 

I took the letter to my doctor about 3 weeks ago to discuss and he went over all the drugs discussed in the letter and gave me his recommendation to think about before the end of the year.

Atripla has been the only drugs i've been taking and since it's been working I really haven't followed any of the newer drugs out there. Thats why I began researching the Juluca they listed in the letter. Actually i've been researching them all but Juluca kind of stood out to me a new options that may be less toxic to my body if I can be able to take it.

Thanks for everyones feedback thou.. =)

I understand.  I have been taking Atripla (or its components) since Dec. 2005 - I too have begun talking to my doc about changing.  Not because of insurance push -- but in hoping I can lessen the # of drugs I take.  Due to low level resistance of most nukes, I also am taking boosted Reyataz along with Sustiva and Descovy.

Mike
Title: Re: United Healthcare - No longer covering Atripla
Post by: gafry53 on December 09, 2018, 08:16:06 am
I have been paying for my Atripla for the last 6 years. I get the generic from Universal drug store in Canada. Check it out
Title: Re: United Healthcare - No longer covering Atripla
Post by: kentfrat1783 on December 09, 2018, 09:44:17 am
I cost difference between the brand name and generic is outrageous.  I'll have to keep that in mind.

Just think how much the insurance companies would save if they allowed us to use the generics?  Then again the pharmaceuticals in the USA wouldn't allow that. 
Title: Re: United Healthcare - No longer covering Atripla
Post by: bufguy on December 14, 2018, 10:01:54 am
symfi and symfi lo are the alternatives to Atripla..The "lo" has  400mg of efavirenz vs. 600mg in the regular symfi and atripla. Even though symfi is generic, the list price is $1700 as opposed to over $3000 for the latest "first line" recommended meds.
Title: Re: United Healthcare - No longer covering Atripla
Post by: MitchMiller on December 14, 2018, 11:18:40 pm
The generic list price of $1700 is still crazy high.  I'm hoping PEPFAR approved versions of Atripla start to compete with Mylan's after the 18 month exclusivity period granted to the first generic provider.  The monthly price should be about 1/10 of that.  Write to your Congressman to complain. 
Title: Re: United Healthcare - No longer covering Atripla
Post by: gafry53 on April 21, 2019, 05:49:20 am
The medicare doughnut holes is around $ 5100  dollars for medications
your screwed if you are not rich or on the Ron White program. 

 So try Universal Drug store and get Viraday for $2000 per year or 

 aids-drugs-online.com for less  and save.
Title: Re: United Healthcare - No longer covering Atripla
Post by: Expat1 on April 23, 2019, 05:15:31 am
Teevir the generic form of Atripla is manufactured by Mylan same as Simfi.   Cost of Teevir in Thailand is between $30 and $70 for a month supply of 30 tablets.  So the difference in cost between Simfi and Teevir (which are pretty much the same) is profiteering.  Charging the maximum the market will bare.  It should be CRIMINAL.