45 loads in 7 days - is PrEP even a factor?

[Guest JizzDumpWI]

I agree. I am surprised an insurance company would not cover prevention. How do they do on other prescription coverage?

[Pighole88]

@RawTop - I'm still working that out with the insurance company but they aren't responding (Anthem of California isn't exactly known for having world-class-service). I did get the Gilead Truvada Copay Assistance coupons for $250 but $750 is still a month's rent for me! If it's a deductible I'll find a way to make it work. Having way too much fun right now to let a one-time cost like that stand in my way. A friend of mine who has an HMO is covered completely on it - unfortunately I just signed up for my new insurance in January so won't be able to switch again for a year. (A year of no anon loads? That's no fun!)

@JizzDumpWI - Honestly haven't had them long enough to have any experience with anything else preventative. Anthem is owned by Blue Cross, whom I've had from various other states (MA, TX) and they've always been pretty good. I just need to keep running this up the totem pole for the next month and make sure they understand the situation.

[Guest JizzDumpWI]

Best to you... Try to get a hold of their entire formulary. Maybe the study doc can feed them information as well...

[Pighole88]

Speak of the devils, apparently it's not covered because it's a brand name prescription - I'm only covered for generic. Sadly Gilead has patented Truvada and the patent license doesn't expire until 2017.

[Guest JizzDumpWI]

then too there isnt a generic approved. your study doc should be able to give them info to reconsider...

[Guest JizzDumpWI]

i would also suggest reaching out to gilead to see if they have a program to help you coming off the study. some years back i was part of a study and the mfg did that for me post study.

[rawfuckr]

Speak of the devils, apparently it's not covered because it's a brand name prescription - I'm only covered for generic. Sadly Gilead has patented Truvada and the patent license doesn't expire until 2017.

I thought all the new plans with the ACA would cover Truvada.. maybe just at a higher copay if they put it on a higher tier. I got one individual Silver plan with BlueShield here in California and they are covering PrEP no questions asked. I had to pay $250 yearly deductible but that's it. Gilead is picking up the copays so my cost is now zero. I just ordered a 90 day supply and BlueShield paid all $3500 for it... or so they say they did. I really doubt that's how much they pay to Gilead.

Pighole88, you should really try to make an effort to get yourself continuing on PrEP. If you seroconvert the cost of treating your HIV will be so much more than what PrEP will cost, let alone the heavy toll on your health and lifelong consequences.

[rawfuckr]

Gilead will cover $200/month. $1000/month means the insurance company isn't paying for any of it. I'm a little surprised by that. Most insurance companies will cover it since they can't tell the difference between Truvada for a poz guy and Truvada as PrEP for a neg guy. Could the $1000 be a deductible that ends after the first month and then you have coverage?

Some insurance companies have started to require prior authorization when Truvada is prescribed 'without a third agent'... that is for PrEP use. United Healthcare is one of them. The PA is actually very simple and it's just the doctor stating the person is at high risk, reporting condomless buttfucking will suffice. There are really no insurances out there who are not covering Truvada PrEP and most of them have it on Tier 2 as a prefered brand drug so the copays are also not that crazy. It just takes a little bit of shopping around to find the right plan for everyone.