For How Long Insurance Companies Are Going To Cover Prep?

[Guest kazore]

 

Here is what I found on another Prep.

I wouldn't be surprised if my insurance company sends me the same letter.

 

Before Prep I only went to the doctor every year or every 2 years for a check up.

Since I started prep I went like 6 times already. I had 4 or 5 blood works and std tests. plus the cost of prep. My premium is $570/month. Before they were making money with me, now they are loosing a lot.

I told my doctor I was feeling like a spoiled kid. Insurance companies, countrary to Europe are for profit businesses. they're going to have to raise their premiums (like they are already doing +15% every years on average) or stop covering Prep.

This is not sustainable on the long term. We are not living in a country were the health care system is supported by the government. For how long Gilead is going to charge so much for their drug? It should be way more inexpense.

Edited May 19, 2015 by kazore

[rawfuckr]

 

Before Prep I only went to the doctor every year or every 2 years for a check up.

Since I started prep I went like 6 times already. I had 4 or 5 blood works and std tests. plus the cost of prep. My premium is $570/month. Before they were making money with me, now they are loosing a lot.

I told my doctor I was feeling like a spoiled kid. Insurance companies, countrary to Europe are for profit businesses. they're going to have to raise their premiums (like they are already doing +15% every years on average) or stop covering Prep.

This is not sustainable on the long term. We are not living in a country were the health care system is supported by the government. For how long Gilead is going to charge so much for their drug? It should be way more inexpense.

 

Don't remember the name of this insurance company, but they already backtracked. They are going out of business and they are trying to save every single dime.

Insurance companies that are concerned with the cost of Truvada have Prior Authorizations that require to make sure this is given out only to high risk groups. Insurance companies are not stupid and if they can give Truvada to the right people, virtually anyone in this forums, they'll save money long run. 

[curiousaboutbb]

Bottom line is It all comes down to money for an insurance company. Don't forget insurance companies negotiate the price of the drugs, they pay much less than the retail price. It is more cost beneficial to prevent HIV than to treat. I think it is something like 12,000 per year to prevent and almost 30,000 to treat. Add to this the fact you are dealing with high risk individuals (not if but when) it makes it even more beneficial to prevent. It's really a no brainier. Assurant has already reversed its decision not to cover and contacted those that received this letter.

[fskn]

It is probably not legal for an ACA-compliant health plan to categorically refuse to cover Truvada for PrEP. In California, this would also be contrary to state law.

Of course, to cover does not mean to cover affordably. Plan features such as high annual deductibles, percentage coinsurance at any level, or high fixed-dollar copayments, mean that patient cost varies based on the quality of the plan. Each year, plans can increase all of these amounts.

Even high-quality plans can manipulate patient cost. For example, though Truvada for PrEP is on the prototype formulary for ACA plans in California, some insurers have placed it in a "specialty" tier with a higher copayment. Other plans have restricted access by, for example, limiting the allowed supply of Truvada for PrEP to 30 days and requiring the prescription to be filled at one specific pharmacy. Some plans and providers also make separate, full charges for multiple blood tests performed together, even though the phlebotomy work -- a major part of the cost -- is not repeated. Finally, when a plan involves standalone doctors' offices and laboratories, most of these do not support internal or external electronic communication, which means a doctor's office visit fee every quarter to get a laboratory requisition, and another office visit fee to get results.

On the question of cost to insurers, if PrEP is given to patients at a truly high risk of getting HIV, and if efforts are made to motivate adherence, it will be cheaper than treatment in the long run. All bets are off if the mandate to carry health insurance is dropped, or the requirement to provide coverage without regard to a person's health is dropped, or some other factor results in "dumping" HIV-positive patients back into public plans such as Medicaid/Medi-Cal.

On the insurer cost side, a very positive factor is that the patent on Truvada will expire soon, allowing generic drug manufacturers to step in.

Edited May 29, 2015 by fskn

[PrEPpedForCum]

On the insurer cost side, a very positive factor is that the patent on Truvada will expire soon, allowing generic drug manufacturers to step in.

 

One of the Truvada patents expires Sept. 29, 2015, but the patents dealing with its use as a prophylactic treatment for HIV does not expire until July 25, 2017. http://www.drugs.com/availability/generic-truvada.html