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Author Topic: Epzicom Non-Preferred Brand Drug by Aetna  (Read 3335 times)

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Offline contagion

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  • Posts: 88
Epzicom Non-Preferred Brand Drug by Aetna
« on: August 25, 2014, 10:44:34 pm »

I'm on Epzicom and Tivicay on United Health Care and had no issues getting the medication for a very low co-pay. Recently though my stupid employed changed their insurance provider to Aetna.

Aetna covers Tivicay but not Epzicom and lists it as a non-preferred brand drug. It doesn't cover it fully and I have to pay $568 to get it. With co-pay assistance from Viread that is still around $368 which is too expensive for me. Has anyone had experience with this? I wrote a complaint to Aetna and they just gave me a lame reply with a copy/paste of my benefits! How horrible can health insurance companies get? I recently switched from Truvada to Epzicom. Is my only option to switch back to Truvada? My VL has remained UD on both meds. But if things couldn't be worse my CD4 dropped from 628 to 221 for no apparent reason. VL % increased and so my doctor is not worried. But I'm still concerned about making another switch from Epzicom to Truvada.
I have a t-shirt with my t-cells on it.

Offline eric48

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Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #1 on: August 26, 2014, 08:08:28 am »
Since you were on Truvada before, is there any reason why you would not want to return to it ? Tivicay + Truvada sounds good to me... (I can not get Tivicay here because it is not yet available)

Your CD4 count drop: once I had a +700 increase (yes, you read correctly)
once I had a 400 drop. But % kept on steady rise

There should not be much worry there
NVP/ABC/3TC/... UD ; CD4 > 900; CD4/CD8 ~ 1.5   stock : 6 months (2013: FOTO= 5d. ON 2d. OFF ; 2014: Clin. Trial NCT02157311 = 4days ON, 3days OFF ; 2015: https://clinicaltrials.gov/ct2/show/NCT02157311 ; 2016: use of granted patent US9101633, 3 days ON, 4days OFF; 2017: added TDF, so NVP/TDF/ABC/3TC, once weekly

Offline Rhaegar

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Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #2 on: August 26, 2014, 12:09:16 pm »
Was there no way for your doctor's office to do a prior authorization for the Epzicom?  If you're stable on a current medication, it should be able to be approved if a prior authorization is submitted to the insurance company.
05/19/2011: Diagnosed.  CD4 159   VL 284,000.
04/29/2013:  CD4 789,   VL <20

Offline contagion

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Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #3 on: August 28, 2014, 12:17:36 am »
@eric48 I guess I might have to go back to Truvada. I have horrible gas and we thought it was coz of the Tenofovir in Truvada and previously - Stribild & Atripla. Tivicay/Epzicom is the first combo I've been taking without Tenofovir. My theory was wrong and I still have gas issues lol. So I might as well go back to Truvada/Tiv. I was just concerned about switching with my current CD4 blip and the fact that I only recently switch from Truvada to Epzicom.

@Rhaegar I spoke to Aetna and they didn't mention anything about prior authorization. My guess is that even with prior authorization they will only cover it according to my plan - which is basically a fixed % for a non-preferred brand drug.
I have a t-shirt with my t-cells on it.

Offline Almost2late

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  • Posts: 1,191
Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #4 on: August 28, 2014, 01:01:59 am »
Maybe Aetna will cover the new Trivicay/Epzicom combo..  Triumeq I think It's called, Have you looked into that?
"Hang on to your hopes my friend..
thats an easy thing to say,
but if your hope should pass away,
simply pretend that you could build them again"...

Offline tednlou2

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Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #5 on: August 28, 2014, 02:22:44 am »
I think there should be a law that insurance companies must cover an HIV med a patient is already taking, when an employer switches or the insurance company changes their formulary.  We aren't talking blood pressure meds here. 

Even if there was no medical reason the patient couldn't take another drug, switching is not done lightly.  I hope you can get it worked out. 

Offline MitchMiller

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  • Posts: 639
Re: Epzicom Non-Preferred Brand Drug by Aetna
« Reply #6 on: September 07, 2014, 02:37:45 am »
Why don't you just switch to the two individual drugs that are in Epzicom.  Both are now generic in the US (abacavir and epivir).  There's no need to take Epzicom when you can get the same thing in two pills that are generic and may then be covered by your insurance.  You then have the choice of taking all the pills once daily or taking them twice daily.

FYI:  I've found that taking the pills twice daily results in less side-effects.  I just switch back to Epizicom (Abamune L) because it is quite a bit cheaper from my overseas pharmacy and I immediately noticed side-effects.  That makes sense since the maximum concentration is much higher when you take one pill once per day rather than twice daily.  I can feel my body is adjusting to it, but I would rather do twice daily dosing to limit the C-max that my body must withstand.


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