Why is my Triumeq free?

[etaoinshrdlu]

Hello all. Occasional lurker, first time poster.

I had been on Epzicom plus Reyataz for several years. My insurance copay was $100 every 3 months ($50 per drug, 90 day supply). In January this year my doc switched me to Triumeq. When I filled the prescription, the copay was $0! I certainly didn't ask why. This persisted for the refill in April and again in June. The insurance company is Cigna.

In August I changed jobs. My current employer offers only those dreaded high deductible "consumer driven" plans. It's also administered by Cigna; interestingly, my account number there didn't change. When it came time for the August refill, I was expecting to have to pay the $3,000 deductible (90 days of Triumeq is about $6,700). Imagine my surprise when again there was no charge. But what's especially nice is that an imaginary $3,000 has been credited to my deductible, so I'm covered there for the remainder of the year.

Has anyone else seen anything like this before? It's almost like Cigna is automatically applying the value of one of Viiv's copay cards to what I would otherwise have to pay out of pocket. If that's the case, I wonder why they didn't do that with the Epzicom? Or maybe there's something cool about Triumeq that Cigna really likes?

Anyway... just curious about your opinions. I'm certainly not going to ask Cigna, haha.

[Jeff G]

You have probably met your deductible for the year and are now at full coverage .

I am on medicare so I have a copay for a few short months and then catastrophic coverage kicks in once my deductibles have been met and then no more copays that this year, maybe this is why you have no copay this month also. 

[etaoinshrdlu]

Jeff -- that's not the case. On my previous plan there was no deductible and no co-insurance. It was the older style copay system ($10 for office visit, $25/$35/$50 three tier pharmacy, etc.). On that plan, the Epzicom and Reyataz copays were $50 each, while the Triumeq copay was always $0.

On my current plan, there is a $3000 deductible. The most recent Triumeq refill was my first claim on this plan, so there had been no payments toward the deductible. I was fully expecting to pay $3150 to get the prescription filled -- $3000 deductible plus the $150 coinsurance for name-brand drugs. Indeed, when I log into my Cigna account, I see "Fill date: August 28; plan paid: $3604.54, you paid: $3150.00." But I actually paid nothing. Furthermore, the deductible tracker shows "Amount: $3000. Met: $3000. Remaining: $0."

The only thing I can conclude is that Cigna is actually sending my balances to Viiv's savings card program. That program pays for up to $6000 per year for Tivicay and Triumeq. That's mighty nice of them; certainly not something I'd expect from an insurance company!

[Jeff G]

I see … Maybe someone else with private insurance can help … Im stumped 

[Seeker]

Is it possible that when you received this prescription at your doctor's office that you were also enrolled in the viiv healthcare program--this covers the cost of the co-pay when you have private insurance..... Many medications have these sort of loyalty programs that cover the cost.

[etaoinshrdlu]

I asked my doc this question, and he said he didn't do any enrollment. When I mentioned that Cigna wasn't charging me anything, his reply was, "Don't ask them why!" Heh.

[AusShep]

I asked my doc this question, and he said he didn't do any enrollment. When I mentioned that Cigna wasn't charging me anything, his reply was, "Don't ask them why!" Heh.

I'm 100% with your doc on this one

It doesn't look like the ACA did anything as far as transferring out of pocket expenditures between insurers, but since you're with the same insurance company, it could be done on purpose, or it could be a bug, either way I wouldn't stir the waters...  Since your plan shows your deductible as met, just go with it.

The only thing similar I've had happen is when an employer switched providers mid plan year, so they waived/payed the deductible for everyone as a benefit (they were much lower in those days), but you'd probably know if your new employer did this for you.

[scooter24]

I have Cigna and am on Triumeq as well. However, CVS manages the prescription plan. Is that the same for you?

[scooter24]

So I did some more research into this and it sounds like exactly what you thought it is. If you're on a high deductible plan and you fill a 90 day prescription for 6K. Whatever the insurance doesn't cover goes towards the deductible and out of pocket max. This sounds quite awesome. It'll take me two fills to hit the out of pocket Mac but then after that, I don't pay anymore for in network healthcare. If I could hug you, I would. You easily saved me $1500.

[etaoinshrdlu]

I have Cigna and am on Triumeq as well. However, CVS manages the prescription plan. Is that the same for you?

No, my plan requires me to use Cigna's own mail-order pharmacy service.

So I did some more research into this and it sounds like exactly what you thought it is. If you're on a high deductible plan and you fill a 90 day prescription for 6K. Whatever the insurance doesn't cover goes towards the deductible and out of pocket max. This sounds quite awesome. It'll take me two fills to hit the out of pocket Mac but then after that, I don't pay anymore for in network healthcare. If I could hug you, I would. You easily saved me $1500.

Doctors should tell everyone about these prescription cards from the drug companies. Glad I was able to help you save some money.

[PittGurl]

i have a question on this whole drug thing - right now I have state insurance but am looking for a job that will offer healthcare.  As Im considering different positions and companies and accept a job - will they know about my DX and meds? Will the HR Dept be notified that this "new employee" is going to cost alot of money with their healthplan due to medication and dr visits? 

[AusShep]

They won't know with any normal insurance plan.

[etaoinshrdlu]

Apologies for the minor necrobump...thought I'd update you all on my discovery.

It was September when I first wrote, after I had received a "free" Triumeq 90-day refill. When December rolled around, I received yet another free one. Then in March this year, when I called Cigna's mail order pharmacy for a refill, they wanted to charge me $3150 ($3000 deductible and $150 coinsurance).

Figuring I now had nothing to lose, I asked the rep why it was previously free for me. She said, "You had a prescription copay card. It expired at the end of last year." Ah ha! Just as I had thought -- somehow one of Viiv's cards was previously applied. I have no clue how this happened, though.

Nevertheless, I was ready: I had already visited Viiv's web site to obtain a new copay card. I recited the numbers on this card to the Cigna rep and my amount due dropped to $0. The card will last all year. Lovely! She said I can do this every year.

It's so easy! I encourage everyone reading this to investigate whatever options are available from your drug company. You'll likely find something that will save you thousands of dollars a year.

One important lesson: be sure to time your refills so that you can get your first refill in January. This is when deductibles reset. Because these cards actually help you meet your deductible (with some else's money, heh), you can avoid having to pay deductibles for other medical expenses. Let the January refill meet your deductible, then any other claims you have for that year will be paid by your insurance company.

[positivemind16]

can foreigners buy insurance in USA and get free triumeq? thank you