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Author Topic: Medicare coverage  (Read 592 times)

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Offline Palliate

  • Member
  • Posts: 9
Medicare coverage
« on: January 01, 2019, 11:43:48 am »
I'm 63 y/o, poz for 6 years, undetectable since spring of 2014. I did have a very low detectable count in October, but we think it was a fluke.

My question: it has been in the news, that Trump wants to deny treatment to Medicare patients. What do you know about the current standing of this? I'm supposed to go on Medicare in September 2020. What will I do if Medicare coverage for HIV treatment is denied?
Infected Spring 2012
Seroconverted probably in June 2012
POZ test 10/22/12
CD4 549 VL 171,000+ as of 11/09/12
Started Atripla 11/28/12

Offline MitchMiller

  • Member
  • Posts: 599
Re: Medicare coverage
« Reply #1 on: January 02, 2019, 12:27:59 am »
I'm not sure where you got the idea Trump would deny treatment to HIV+ patients on  Medicare.  The reality is that HHS has proposed allowing companies selling Medicare Part D policies to exclude some HIV drugs from their formularies.  You may remember that some pharmacy benefit manager companies excluded Gilead's Hep C drug due to its price, but did make a cheaper competitor's drug available.  It's likely that at least one drug of a particular class would be required to be available.  Another proposed change is to require prior authorization before a patient can be prescribed a more expensive medication than the one currently prescribed.  The patient may be required to try cheaper drugs first (step therapy).  My private health insurer (United Healthcare) uses step therapy for HIV drugs as part of my Obamacare plan.

I'm 62 and am patiently looking forward to Medicare.  I'm not really concerned about these changes, although all of my medications are now generic, so I'm certain they will be covered by all Part D plans.

« Last Edit: January 02, 2019, 12:32:18 am by MitchMiller »

Offline leatherman

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  • Posts: 7,489
  • Google and HIV meds are Your Friends
Re: Medicare coverage
« Reply #2 on: January 02, 2019, 06:36:39 am »
thank goodness, what the POTUS might want to do and what law/budget Congress will pass are vastly different things.  ;)

As to what you can do: If you didn't vote for a candidate who is actually for continuing Medicare or for universal health care, then you're in luck as another election will be coming up in 2020. You can also pester, I mean advocate :D to, your local state and federal legislators to pass laws upholding Medicare.

I'm not sure where you got the idea Trump would deny treatment to HIV+ patients on  Medicare.
I'm not really concerned about these changes, although all of my medications are now generic, so I'm certain they will be covered by all Part D plans.

In 25 yrs of meds with nearly 2 decades of that time using Medicare and Medicaid, I've never been on generics and I have always been deeply concerned about any proposed change or real change to HIV treatment and access to health care. I'm a firm believer that without constant advocacy for access to health care and for the Ryan White Care Act that people living with HIV are always in danger of losing our health care.

We've already seen this administration steal RW monies to pay for kidnapping and holding immigrant children and families, along with cure research funding being cut. Many people living with HIV rely on Medicare and Medicaid and we should always be concerned about what could happen to these programs as these programs provide health care, meds, and a better life (if not life itself thanks to the treatment) to thousands and thousands of PLWH
leatherman (aka mIkIE)

There's no rain, there's no storm, though the blue sky makes you wonder
Don't you fear what will come will come
And right now we're in the sun
Sure enough, seasons change
But don't let today get lost 'cause today the sun's on us
Today the sun's on us
- Sophie Ellis-Bextor

chart from 1992-2017

Offline moviegoer

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  • Posts: 2
Re: Medicare coverage
« Reply #3 on: February 08, 2019, 06:53:39 pm »
Hey everyone,  I just switched over to Medicare, and was shocked at the cost of Atripla.  First month was $1000 copay.   This, and many other HIV drugs are considered specialty medications, so Medicare and BCBS (supplement) require subscribers to carry more of the costs of these drugs.  After having excellent private insurance where my copay was $100 (and even that was often waived by coupons provided by the manufacturer of Atripla), this has all been a massive shock.

So, I ordered generic Atripla from India, Viraday, for $240/ 3 month supply.   Very easy process.  However, I know of no one who's done this, and I recognize that meds manufactured in India are not regulated by the FDA, so the risk is they are not effective, etc.   Has anyone gone this route?  Know of anyone who has?   I'm pretty conflicted and confused by the whole thing.    Thanks!

Offline Expat1

  • Member
  • Posts: 183
Re: Medicare coverage
« Reply #4 on: February 09, 2019, 05:38:38 pm »
Most of the world takes generic HIV meds.  Viriday is among the best (generic for Atripla) and it is made by Cipla with is one of the largest generic drug manufacturers.
and FYI.

Cipla Inc was  approved by US FDA in 1985.  Cipla has provided generic  medicines to US patients for over 30 years. The hiv drugs are certified by Global fund.

I believe that the high price might have been due to a generic formulation being availiable in the US. Get a copy of your companies formulary.  Check the Tier level of the drugs.  Also there are maximum out of pocket costs etc.

Offline Expat1

  • Member
  • Posts: 183
Re: Medicare coverage
« Reply #5 on: February 09, 2019, 05:40:37 pm »

Offline moviegoer

  • New Member
  • Posts: 2
Re: Medicare coverage
« Reply #6 on: February 10, 2019, 10:08:41 am »
Thanks very much to the most recent two postings.   I don't believe there is a generic for Atripla in the US, as the pharmaceutical company that manufactures Atripla still holds a patent here.   But very helpful to hear about Viraday.   I'll continue to do more research.   I'll keep you all posted on what I find out.   Thanks again!

Offline Expat1

  • Member
  • Posts: 183
Re: Medicare coverage
« Reply #7 on: February 10, 2019, 10:23:03 am »
Mylan also makes three-drug combos, Symfi (equivalent to Atripla, which costs $32,000) and lower-dose Symfi Lo. At 40 percent less, the two Symfi combinations cost $19,200.

Which is the same generic as Viraday.  Now availiable in the USA.

Also the three drugs in ATRIPLA also are availiable as generic.

I dont know your income or state but you may qualify for the copay part being paid by ADAP in your state.  Contact an ASO  Aids Serivice Organization.

Offline Expat1

  • Member
  • Posts: 183
Re: Medicare coverage
« Reply #8 on: February 10, 2019, 10:29:54 am »
Mylan the manufacture of Symfi makes a similar generic combo to this in ASIA called TEEVIR which is what my partner takes, and it costs about $40 per bottle.

You could also hop on a plan and vacation in Thailand.  Buy real Atripla in Pattaya Memorial Hospital for 3600 baht a bottle.  Or Generic Teevir for 2700 baht  a bottle.  ($115 and $90 respectively) > Bring your lab results, empty bottles, with you if you do this.  Lots of people in Asia get meds in Thailand because of costs.

Offline Expat1

  • Member
  • Posts: 183


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