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Author Topic: Have insurance and copay assistance from Gilead but Complera still over $500/mo!  (Read 8457 times)

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Offline dcity

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  • Posts: 9
I was recently diagnosed in October and have been on Complera since December. I mentioned my concern about cost to my doctor and he offered me the Gilead Co-Pay Assistance Program Card (which certainly does help alleviate some of the cost of the meds each month). However, Im still paying more than $500 after insurance and the Gilead "coupon" every month for a 30-day supply of meds.

Is there a less expensive option? Need I switch to a different medication?

I've read throughout the forums that people pay around $30 a month- is this possible?

I would greatly appreciate any and all input! Thanks!

Offline jb1973

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  • To thine ownself be true
I think how much you pay depends on the type of prescription coverage you have through your insurance and if you have a deductible to meet. For example, my yearly deductible for medication is $250 and then after that it is $20/month for my meds.
Call your insurance and ask if you have a deductible. If not the case then it could just be poor prescription coverage that your employer offers.
??Infected - 08-09??
3/3/11-tested POZ
3/18/11 - CD4-534 VL-6,600
6/24/11 - CD4-642 VL-10,800
10/11 - CD4-580 33% VL-9,900
1/12 - CD4-602 ?% VL-9,700
3/12 - CD4-552 27% VL=10,684
8/12 - cd4-550 24% VL=9.865
Started Isentress/Truvada
10/12- CD4-613 31% VL=UD

Offline mitch777

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Hi dcity,
have you tried checking in with your local ASO to find out if your state's ADAP would cover the copays?
my insurance coverage is good, but ADAP covers my copay.
i'm not sure where you live, but if you were able to provide a bit more info others on this site may be able to help you more.
this is also a great place to ask questions and learn from others.
33 years hiv+ with a curtsy.

Offline dcity

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  • Posts: 9
Hey all thanks so much for your input. I currently live in NYC.
How do I look into the ADAP or ASO?

Offline emeraldize

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The above link some ASOs in NYC may get you started but there are some smart guys on the forum who can save you time. I will PM one of them and others may chime in meanwhile.

Offline dcity

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Thank you for the heads up emeraldize. I'll look into the NYC ASO link in the meantime.

Offline Jody

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Hey dcity, welcome...Depending on income requirements that vary with each state you can contact ADAP New York at tel. # 1-800-542-2437.  They also help people with doctor visits, etc through ADAP plus if you qualify.  ASO's vary by borough (county).  In Queens we have ACQC (AIDS Center of Queens County in Jamaica, NY). You can also contact GMHC.org for info.  PM me if you have any issues.

"Wake up to find out that you are the eyes of the world".
 "Try to discover that you are the song that the morning brings."

Grateful Dead

Offline dcity

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  • Posts: 9
Spoke to my Dr today- he suggested applying for the ADAP as well as contacting Gilead for an additional patient assistance program (in addition to the co-pay assistance). We discussed switching to Atripla since its considerably less expensive. Any thoughts?

Offline gadawg1979

  • Member
  • Posts: 142
I was in a similar situation and it may be that ADAP will not cover you because of your insurance, but your ASO can work with you to get you a PAP.
Diagnosed March 2012
Initial CD4- 156 VL 200K (started Complera) Genotype test no resistance
First labs on meds CD4- 246 VL 2K Taken after 30 days on Complera
90 Day labs VL 306 No CD4 Drawn
8/21/2012 CD4 474 VL Undetectable (40) %20.6
11/27/2012 CD 4 522 VL Undetectable (40)
2/14/2013 CD 4 464 VL Undetecable (30) 19.6%
6/8/3013 CD 4 528 VL Undetectable (30)
9/24/2013 CD 4 546 VL Undetectable (40)
1/30/2014 CD4 560 VL Undetectable (40) 22 %
6/19/2014 CD4 584 Vl Undetecable (30)

Offline dcity

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  • Posts: 9
I just sent in my ADAP application today.

I called Gilead to speak to them regarding the Patient Assistance Program. They said that they couldn't help me financially in addition to the co-pay assistance program because I still have insurance.

Any insight into how long the ADAP process takes?

Also, naive question- what is an ASO?

Offline Miss Philicia

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An ASO = AIDS Service Organization

Someone already suggested that you go to GMHC since you live in NYC. They have case managers that can assess your situation more thoroughly vis-a-vis your insurance and what New York state programs exist that can fill in the holes. NY has more than just ADAP, there's also AHIP and APIC among others.


If I were you I'd fish around on their web site and figure out when they do "intake" days as I think you have to register officially as a "client" first. You should also obtain, if you don't have it already, your insurance benefit package that lays out exactly what your deductibles are, drug formularies, etc. You should receive one of these from your employer and/or insurer annually. At least this way you'll know if you're obtaining the most assistance that you are qualified for.

ADAP, from what I recall, is approved somewhat quickly but it may be an entire month. Probably more like 3 weeks. However, most places have some way to expedite the first month pending approval, but it needs a case manager to sign off on it.
"Iíve slept with enough men to know that Iím not gay"

Offline oksikoko

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  • Writing the congressman again
I just sent in my ADAP application today.

I called Gilead to speak to them regarding the Patient Assistance Program. They said that they couldn't help me financially in addition to the co-pay assistance program because I still have insurance.

Any insight into how long the ADAP process takes?

Hey, dcity. I live in NYC too and in the past month have dealt with Gilead's PAP, ADAP and the insurance thing. Maybe my timeline will help? This stuff is all very complicated, so don't be alarmed if it's overwhelming. It felt like years, but was only a few weeks. I'm sure I drove people here nuts in that period, but I don't have any way to pay for the prescriptions, and I only started in December. It was a little much to already be having a medication crisis. ;)

Let's see:
Previous case manager applied for ADAP in the first week of January.

I ran out of Stribild in the middle of January and Gilead let me in their PAP on a temporary basis - 3 months max or until I got ADAP coverage. The letter specifically says I had from 1/7 until April OR until ADAP. They covered one bottle in toto, and I'm ever grateful.

I was approved for ADAP around the 15th of January, but I didn't find out right away, so panicpanicpanic. ;). It didn't take long, but I didn't fill out the initial paperwork myself. I've since taken more control of my own situation, but I'm still catching up with everything that was done on my behalf. For the record, my old case manager was excellent with paperwork, and I should be more thankful. They and the doctor are crap on bedside manner and made me feel terrible and dependent *all the time*. Enough of that talk. GMHC helped me get a new doctor  on Thursday (Wednesday?) who I'll be seeing in about a week.

This may be relevant to you too. I have COBRA eligibility, so the NY Uninsured Care Program (who administer ADAP) enrolled me in the Coordination of Benefits program. So, basically, from next month they pay the premiums for COBRA, and I use my old insurance card for prescriptions. If there's a problem with the insurance, I can use my ADAP card instead, but that shouldn't happen. This means I have to do mail order, unfortunately, which I'm not sure how I'm going to handle, but I have two weeks before panicpanicpanic and an additional week before crisiscrisiscrisis. I hope to take care of this early next week to avoid all that. But all in all, I can't complain.

About GMHC: I'm a client there. It's night and day compared to the people I was sent to by the health department when I tested positive, and I feel like for the first time since 11/20, it's not me against the doctor, me against the social worker, me against the NYC Housing authority, me against the DOL, me against, etc. etc. I don't expect them to solve all of my problems, but I finally feel like someone's in my corner after a long period of not having that. I can't even start listing all the things they've done for me already with the ultimate goal of becoming self-sufficient again and not getting sicker quicker for no reason beyond stress, isolation and lack of stable housing. My point is that I recommend you call and see if you're eligible and interested. Full disclosure: some people really like the place I just ran from. We're all on our own paths here.

You have to do an intake to become a client. Here's the info: http://www.gmhc.org/get-support/get-connected/become-a-client You'll definitely need some proof of HIV status so request that ahead of time if you don't have it on hand.

I don't know how long that takes. I had forgotten, but I was already in their system, I guess as a high-risk negative about a decade ago, go figure. ;) I got to skip the intake this time around.

Good luck!
Code: [Select]
2014-11-14: CD4 Wars Episode II: Return of the Stribild (released in Europe as Stribild II: Werewolf Bitch)
2014-11-06:                ☣ VL (→) 12,627      ☣ CD4 (→) 639
2014-??-??: off treatment  ☣ VL (?)              ☣ CD4 (?)
2013-10-03:                ☣ VL (=) undetectable ☣ CD4 (+) 1105
2013-05-23:                ☣ VL (=) undetectable ☣ CD4 (-) 945
2013-02-25:                ☣ VL (-) undetectable ☣ CD4 (+) 1123
2012-12-16: Enter Stribild
2012-11-20: HIV+           ☣ VL (→) 132,683      ☣ CD4 (→) 920
2012-04-01: HIV-
Dates in this signature file conform to ISO 8601. ;-)

If no one complains, nothing will ever change.

Offline bmancanfly

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  • Medicare For All !
I hope you get you situation sorted out quickly.  My dealings with NY ADAP were always very easy with reasonably quick response times.  GMHC is great.

It's disheartening that so many doctors write 'scripts seemingly unconcerned about the patients ability to pay.  Complera is a new (read expensive) medication that is not any more effective than some older (read cheaper) medications.  Aripla is only one of those cheaper options,  Viramune is another.
I've noticed that my doctor has been pushing Complera on me and some of my friends even though we are all doing well on our current (cheap) regimens.  I would imagine that there is some sort of financial incentive for this,  but I'm not sure.

Not to mention the financial strain that the cost of these newer,  not necessarily better, medications put of assistance programs.

Best of luck in sorting it out.
« Last Edit: February 16, 2013, 05:33:45 PM by bmancanfly »
"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt."

 Bertrand Russell

Offline dcity

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  • Posts: 9
Thank you all so much- I really really appreciate all of your help. Needless to say, processing all of this on my own over the past few months has been fairly overwhelming. My doctor has been very helpful but there is only so much he, himself, can do to help unburden my wallet and my mind. I just filled my script for Atripla on Saturday (to be picked up tomorrow, Monday). Hopefully cost will be LOWER since I will now play the waiting game for my ADAP approval.

I will contact GMHC this week! You have all been insanely helpful.


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