Using Gilead Copay program if your pharmacy doesn't participate

[rawfuckr]

My current pharmacy benefits are provided by Kaiser and when I went to them with my Gilead Co-pay assistance card for Truvada PrEP they laughed at my face and said they don't participate in copay programs. This doesn't mean that you don't get reimbursement, it's just a little bit more involved:

1) Call Gilead copay assistance, the phone is in the card, and ask for a 'reimbursement form'

2) Make sure you keep the prescription label in the Truvada bottle, and the payment receipt to the pharmacy

3) fill out form with RX number, prescription label and receipt.

4) Mail form

After a few weeks wait you'll get a check in the mail with the reimbursement. Up to $200/month so it maybe worth it. Definitely more cumbersome than just having your pharmacy participating in the program, but better than nothing.

Hope this helps for some

[Blueyedsoul]

Rawfuckr: What is your copay at Kaiser usually? Also, I am confused. Is your healthcare provider Kaiser for everything? Or just pharmacy? I thought Kaiser covered PrEP because of the prevention aspect. I see it on their actuarial for medications. What is your copay at Kaiser without the Gilead rebate? Curious because I am looking at Kaiser as a potential provider.

[rawfuckr]

Rawfuckr: What is your copay at Kaiser usually? Also, I am confused. Is your healthcare provider Kaiser for everything? Or just pharmacy? I thought Kaiser covered PrEP because of the prevention aspect. I see it on their actuarial for medications. What is your copay at Kaiser without the Gilead rebate? Curious because I am looking at Kaiser as a potential provider.

Your copay depends on the plan you have. i have an ACA plan and my copays are usually $3 for generics, $5 for brand name drugs. My plan is hard to get though, so for regular folks the silver level copays are $20 for generics and $50 for name drugs after a $250 yearly deductible, which is fine because Gilead will pay for most of it, all of it after the first month. For a platinum plan you'd pay $15 per Truvada prescription, no deductibles. This is Kaiser in California. You just have to look at what's the tier where Truvada is in (Kaiser is tier 2) and what the prices for that tier are.

If you sign up for Kaiser, you have to use Kaiser for everything. From lab work to pharmacy, you have to use their labs and their pharmacies. I personally don't care where I get my drugs, is the same to me. Their mailing program for their pharmacy is actually super convenient and you can get your drugs in the mail using the internet or a phone app very easily. If you have to get your drugs in the pharmacy you have to physically go to one of their pharmacies. Their lab turnaround time is also spectacular and you get test results in your phone app sometimes in a couple of hours after the blood drawn.

Take a look at my main post about Kaiser and PrEP to know more about the costs. It's more than just the Truvada RX.

[seaguy]

Kaiser is a unique case I think due to it being managed care and having its own network and pharmacies rather than contracting with communityu providers and pharmacy chains.

[jtonic]

Can anyone advise on the possibility to using Gilead's copay program if I'm in Canada?

[seaguy]

Can anyone advise on the possibility to using Gilead's copay program if I'm in Canada?

You might get a quicker answer by calling them or visiting the canadian truvada website.

[jtonic]

You might get a quicker answer by calling them or visiting the canadian truvada website.

I tried calling Gilead and only found the US number. The lady wasn't able to give me an answer and said to ask my pharmacy. My pharmacist said to call Gilead. I don't know what to do. From this website, it appears that the program is only available in the US. Gilead Canada does have its own website. I emailed their information contact last week, no answer. Calling the number only gives options to reach an extension or redirects to the website for information on the drugs.

[fskn]

The Gilead programs (there are three: full payment for patients without prescription coverage; routine out-of-pocket reimbursement up to $200 per month; and reimbursement over $200 per month, by application) apply only to US patients not participating in governmemt health plans such as VA, Medicare or Medicaid/Medi-Cal.

In Canada, PrEP remains an off-label use of Truvada. If you have supplementary health insurance, it is possible that your insurer will cover the cost.

(For Americans: Canada's provincial health insurance plans cover medical services but have never covered outpatient prescription drugs. Separate programs do cover drugs for seniors and low-income earners. In the same way that most Americans rely on employer-sponsored insurance for all medical care, Canadians rely on it for prescriptions.)