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Author Topic: Complera not on preferred drug list  (Read 1979 times)

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Offline yogalover

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Complera not on preferred drug list
« on: April 04, 2014, 09:00:51 PM »
So I just found out from talking to someone at Accredo that Complera is not on my insurance plans preferred drug list!! WTF...I had called in a refill last week and when it still hadn't been delivered by when they said it was ..I was informed that my dr needed to call with an authorization(which supposedly is a new thing)..so he did that! Still no delivery and then I called tonight and she informed of this atrocity. Its gonna be a long weekend waiting to call BCBS on Monday to find out if this is true. I am freaking out! Has anyone else had this problem happen to them? I hope it is not true...if it is I don't know what to do.

Offline AusShep

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Re: Complera not on preferred drug list
« Reply #1 on: April 04, 2014, 10:01:05 PM »
I just checked bcbs Texas Rx coverage list.  Complera is one of the few HIV drugs categorized as non-preferred brand, but it's still covered.  Pre auth is not required.

Can you check bcbs online for your State?

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: Complera not on preferred drug list
« Reply #2 on: April 05, 2014, 06:19:20 AM »
Could you get around this by taking the components of Complera (rilpivirine + tenofovir + emtricitabine) in the form of Edurant (rilpivirine) and Truvada (tenofovir + emtricitabine)? Would doing that seriously affect your co-pay?

You'd take it the same exact way as Complera - once a day with food. You'd just be taking two pills instead of one.

I suspect this is the crux of why you're having trouble with it - Complera vs Edurant + Truvada is a convenience issue rather than a efficacy issue, medically speaking. Financially speaking it may be a problem for some if they can't afford an increase in co-pay.

You can read about the various forms of your combo here.

Good luck.
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Offline gadawg1979

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  • Posts: 142
Re: Complera not on preferred drug list
« Reply #3 on: April 06, 2014, 10:08:54 AM »
I had to go through the hoops and the forms and then they approved it with a higher co-pay... Thank goodness for the co-pay card.
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)


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