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Author Topic: anthem virginia  (Read 2253 times)

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Offline gingin

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anthem virginia
« on: December 03, 2013, 09:42:21 AM »
Does anyone know why Stribild is not on anthem's drug formulary for 2014?  I am confused bcause I bought it before on my old anthem insurance policy.  Virginia is limited in insurance choices on new health care act.  thanks

Offline Jeff G

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Re: anthem virginia
« Reply #1 on: December 03, 2013, 09:49:05 AM »
Does anyone know why Stribild is not on anthem's drug formulary for 2014?  I am confused bcause I bought it before on my old anthem insurance policy.  Virginia is limited in insurance choices on new health care act.  thanks

I cant say why its not covered but I do know that if your doctor wants you on that drug he or she can get prior approval from your insurance company and they will approve it .

I have been through the same thing many times and my doctors have always been successful at getting me what I need and it should not be a problem for you either .
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Offline Miss Philicia

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Re: anthem virginia
« Reply #2 on: December 03, 2013, 02:52:18 PM »
Is Stribild officially on the "preferred list" for treatment naive patients per the NIH guidelines yet? If not, I can see an insurance company denying it on the formulary. Basically it's not "medically necessary" when there are other options.

I have had medications (though not HIV meds) denied prior approval from my doctor. In fact it just happened last month.

The current preferred list is:

The Panel recommends the following as preferred regimens (listed in order of FDA approval) for antiretroviral (ARV)-naive
• efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC) (AI)
• ritonavir-boosted atazanavir + tenofovir disoproxil fumarate/emtricitabine (ATV/r + TDF/FTC) (AI)
• ritonavir-boosted darunavir + tenofovir disoproxil fumarate/emtricitabine (DRV/r + TDF/FTC) (AI)
• raltegravir + tenofovir disoproxil fumarate/emtricitabine (RAL + TDF/FTC) (AI)

So, no, Stribild isn't on it. I'm not saying an appeal by your doctor won't work, but I'd also not be surprised if they said you should go on one of those other things unless you can prove with resistance testing that none of those are appropriate. And yes, I can see this becoming more common due to cost.

Hell, I was even denied viral load testing when it initially was approved by the FDA for at least eight months of various appeals by my private doctor, and with a non-HMO Blue Cross (read: expensive) insurance back in ~1997.
« Last Edit: December 03, 2013, 02:55:35 PM by Miss Philicia »
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Offline gingin

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Re: anthem virginia
« Reply #3 on: December 09, 2013, 09:32:05 AM »
Thanks! I appreciate the info.

Offline OneTampa

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Re: anthem virginia
« Reply #4 on: December 11, 2013, 07:39:45 AM »

Thanks for this info.
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