Trying To Obtain Prep, No Insurance, Not Low Income

[bottombitchboy]

Good morning!

 

I'm in a bit of a pickle and hoping someone might have some input. I am trying to obtain PrEP, i belong to the GLBT clinic in NYC where they will write me a prescription and do blood work etc. My issue is payment, I am no longer insured, and i am not considered low income by Gilead. Since I am transgender, i am not able to participate in the study they have where it'd be free (They are seeking MTF transgender, and bio males).

So i can obtain a prescription and get it filled locally which will cost me over 1500 a month, or send it over sees for a generic version. Those are my options, or not go on PrEP. 

 

 

Any thoughts as far as what I can do? I live in NJ and any input is greatly appreciated

 

[fillmyholeftl]

Have you been denied by Gileads assistance program, or just "think" you are ineligible from reading the requirements.  If you haven't, I would call them. they do make exceptions  GOOD LUCK

[bottombitchboy]

I called them and my income is too high. She was unable to point me in any direction as far as low cost or assistance

[tallbtm]

Call your clinic and talk to the "Care Coordinator" or "Financial Assistance" people. I don't know what clinic you go to, but if it's Callen-Lorde, click the link for Get Care on the home page and follow the links to Care Coordination.  

 

But no matter what clinic you use, I guarantee you they have people who can help you get health coverage. Go to your clinic's home page and search for "financial assistance." Or just call the main number and tell then what you need and they'll connect you to the right people who can help you.

 

There is help available. Please let us know what you find. 

[seaguy]

Have you tried signing up for Obamacare?

[fskn]

Have you investigated New Jersey's Medicaid program, and/or Affordable Care Act exchange? (Aside for low-income readers: at least one state is including Truvada for PrEP in its subsidized HIV drug or Ryan White Act program. I learned this in a chance conversation with a state health official, at an HIV prevention conference two weeks ago.)

Because New Jersey is an urban state, Truvada for PrEP is almost certainly covered by the state's Medicaid program and included in the state's model formulary for Affordable Care Act health plans. (You can easily answer both questions online.)

Medicaid is the federal-state insurance program for the poor, and though you mention a high income from Gilead's perspective,* most blue states (historic Democratic Party strongholds) have voluntarily expanded eligibility for Medicaid. The threshold is a multiple of (not one time) the federal poverty line.

If your income is too high for Medicaid, then you will have no difficulty paying the net (see below) monthly premium for an ACA plan. In fact, you will owe a fine with your 2015 income tax return if you do not have equivalent health coverage throughout the year. A mandate to have or buy insurance is part of the Affordable Care Act. You can use your state's online exchange to compare plan designs and prices. You must weigh the prescription drug, lab test and office visit coinsurance percentages/copayment amounts, and the annual out-of-pocket maximum, against the monthly premium, to find the plan with the lowest total cost. Check the drug formularies carefully, in case Truvada is in a high-priced "specialty tier".

Even though you've found a clinic willing to do the initial and periodic testing required for PrEP, and to prescribe Truvada, most insurance plans do not cover items ordered by parties external to the plan. A doctor and a lab who participate in your health plan will have to test and prescribe, if you want the plan to cover PrEP. (It is possible that your clinic participates in one or more ACA plans.)

Most ACA participants qualify for a presumptive tax credit, or subsidy, which reduces the monthly premium. Thus, if you earn too much for Medicaid but not enough to comfortably pay for a silver-tier (mid-level) plan, you will get monthly financial help from the federal government.

* I read recently that Gilead's income cutoff for payment of the full cost of Truvada is $58,000 per year. I have not verified that figure. To be clear to other readers, there is no income cutoff for the copayment assistance program, under which Gilead provides up to $300/month toward one's out-of-pocket cost for Truvada.

[fskn]

One more thing: there is no FDA-approved generic version of Truvada, contrary to what foreign online pharmacies claim (see my posting history for a message on that topic). If you rely on a foreign pharmacy, you have no idea what you are getting; it could be a blue placebo, for all you know. It is also illegal to import prescription drugs into the US. You might get lucky, or your shipments might be seized by customs and you might be fined.

Edited June 26, 2015 by fskn

[Guest TravelGuy4Bareback]

Try the Patient Access Network. They helped me out a bunch.  http://www.panfoundation.org/

[puptrigger7679]

clinically i would not go to foreign markets because it a could be a different active ingredients i would try to get New Jersey's Medicaid program. GL I am also transgender mtf! GL