Recent PrEP Changes in the US

[Guest rookie6969]

12 hours ago, barecubtop said:

1. I used to pay $20/month for Truvada, but with the Gilead co-pay card, I haven't paid anything in months.  Each doctor that I've seen has given me the card. 

2. The current doctor I'm seeing switched me to Descovy a few months ago.  She mentioned that because there was a generic equivalent of Truvada available now, my insurance might force me to switch back to the generic Truvada unless there was proof that I needed to be on Descovy for liver problems.  That hasn't happened, yet...but something to look out for.

There are state and federal programs right now that will pay for your Descovy or Truvada.  I think the federal program only lasts a couple years, but it might be something you want to look into.

[think before following links] https://www.nastad.org/prepcost-resources/prep-assistance-programs

My HMO has a whole department that works with people on PreP and helps them navigate the assistance programs.  California might be more progressive than other states though.

[BootmanLA]

7 hours ago, rookie6969 said:

My HMO has a whole department that works with people on PreP and helps them navigate the assistance programs.  California might be more progressive than other states though.

That's like saying the Arctic Circle might be a tad cooler than the equator.

But every US state has organizations - some governmental, some non-profits - that help people navigate these issues. Many are funded through the Ryan White Act (so that gives you something to google for, in your particular locality). Resources are likely more limited in rural areas than urban ones, but since much can be handled online or virtually, the fact that you aren't in a big city is not necessarily a dealbreaker. 

[fuckholedc]

On 10/18/2020 at 5:17 PM, MantisShrimp said:

This may not apply to me, but for many of you out there it may. 

Ok, for those of you on PrEP, or looking to start.

As many of you know Gilead has held the patent on Truvada, previously the only approved regiment from PrEP in the US.

As of September 2020 a new generic version has been made avaliable from one company, Teva Pharma. Now known by the generic, active ingredient, name tenofovir disoproxil fumarate. Since there is only one generic on the market the overall, gross sticker price (which very few people actually pay) has not really dropped that much. However, with any insurance, such as that received through the ACA, the price should be down. I've heard of about a 90% drop in price in some cases. Furthermore, like Gilead, Teva does offer co-pay assistance. 

Thanks.

And now - a nightmare, made bearable only because we have been forcibly locked inside since March 2020 due to the COVID19 pandemic.

After I got back from my fuck trip back to Europe I tried to renew my Truvada prescription.  My previous prescription was a rational $160 or so for three months (or perhaps per month, I don't remember).  However my insurance plan had changed on Jan 1, 2020.

My health insurance provider tried to charge me $5k+ for a 3 month renewal.  This might have been an attempt on their part to move me to some kind of cost reduction program, etc.  It doesn't matter at all.  It was criminal to try to charge me $5k+ (also my income is not high at all - it used to be before the 2007/2008 crash but I never recovered financially from that). 

My Gay doctor basically shrugged his shoulders and said "oh, well", something I was shocked by.

Perhaps my insurance provider is trying to kill sexually active Gay men?  Sounds dramatic and conspiratorial but the US is a country I will never trust because it has consistently proven that as a society it is out to destroy people.  Perhaps there is a higher money transfer with HIV medication?  

And BTW, the generic version of Truvada does not provide much financial relief right now, coming in at $1455/month.

 

 

Edited December 15, 2020 by fuckholedc
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[Kinkybreed]

I can't wrap my head around the fact that you would have to pay that much for PrEp or hiv meds. When the Prep finally started here in germany last year it was around 40 Euros. The pharmacists at the drugstores also helped where they could and found some ways to make it even more affordable. Now it's absolutely free for everyone, as it should be. Of course we have healthcare here, which covers it all but especially when it comes to hiv medication I just can't understand how a government could be okay with the fact that people would have to pay ridiculous amounts of money just to stay healthy. It's mindblowing. 

[Guest rookie6969]

4 hours ago, fuckholedc said:

Thanks.

And now - a nightmare, made bearable only because we have been forcibly locked inside since March 2020 due to the COVID19 pandemic.

After I got back from my fuck trip back to Europe I tried to renew my Truvada prescription.  My previous prescription was a rational $160 or so for three months (or perhaps per month, I don't remember).  However my insurance plan had changed on Jan 1, 2020.

My health insurance provider tried to charge me $5k+ for a 3 month renewal.  This might have been an attempt on their part to move me to some kind of cost reduction program, etc.  It doesn't matter at all.  It was criminal to try to charge me $5k+ (also my income is not high at all - it used to be before the 2007/2008 crash but I never recovered financially from that). 

My Gay doctor basically shrugged his shoulders and said "oh, well", something I was shocked by.

Perhaps my insurance provider is trying to kill sexually active Gay men?  Sounds dramatic and conspiratorial but the US is a country I will never trust because it has consistently proven that as a society it is out to destroy people.  Perhaps there is a higher money transfer with HIV medication?  

And BTW, the generic version of Truvada does not provide much financial relief right now, coming in at $1455/month.

 

 

That is fucking awful.  i'm sorry you are having to deal with that.  Perhaps try Truvada Access Card.  Also I think the govt. cut a deal with Gilead to provide free Descovy for a couple years.  You might look into that.  Here is an article about options you might have

[think before following links] https://www.consumerreports.org/prescription-drugs/get-the-prep-drugs-descovy-and-truvada-to-prevent-hiv-for-free/

Here is where you can apply for free PreP through the govt.

[think before following links] https://getyourpreppatient.iassist.com/

[PozBearWI]

I gave up on PrEP when I retired.  Virtually no side effects, and I was glad to be protected.  But once retired and on Medicare we buy our drug coverage separately.  And just adding PrEP puts me into a hugely expensive drug plan compared to zero cost right now for everything else.  So no PrEP for me.  I would have no issue with a $40 per month copay; but fixed income does not support much more.

Conversely, at least here in Wisconsin if I poz, I can get free medications through a variety of state programs.  

Now from a public health perspective; I think PrEP is excellent; But until we do here what it appears other nations do and get the cost into a reasonable place; I can't see a case for PrEP.  

[Rillion]

So another change that was made was that PrEP was classified as a preventive as of the beginning of the year (2021), so insurance companies have to cover the entire cost of it.

For me, the cost dropped from $1400 a month for name brand Truvada (which I covered with the copay card until my out of pocket max was hit) in 2020 to $0 a month for the generic in 2021. Insurance company will no longer cover Truvada, so it would cost $600 a month to pay for it myself.

On a slightly related note, got a letter from my insurance company last week saying that starting in 2022 that costs I covered using coupons or copay cards from drug companies would no longer count towards my deductible and out of pocket maximums. That trick was good while it lasted, Gilead basically covered my deductible and out of pocket max for 4 years.

[PozBearWI]

This has been a really helpful thread.  I got a hold of the old ARCW (now Vivint) here in Wisconsin in November 2021 and indeed, they figured they could help me get on a low cost PrEP.  I had not een on PrEP since early 2016 when I went on Medicare and just could not afford a drug plan that provided Truvada (which is what was out at the time).  I did all the intake and testing steps and when it finally came to prescription  the PA decided Descovy would be a wiser choice for me given my medical history.  

When the pharmacy of that organization called me they said I could get it for $700 a month.  I thanked the pharmacist but told them there was no way I could afford such a plan and to just forget the whole thing; thank you very much.  We ended the call and I thought that was the end of it.

Another pharmacist called me back a short while later and suggested perhaps Truvada could be less and offered that.  I replied, sure no problem depending on how much.  That ended that call.  When I talked to them about Truvada cost I said if they could deliver for 20 or 30 a month that would not be a problem for me; but hundreds per month was not going to be workable no matter what.  (to answer a question I know will be out there, in this area HIV meds are free.  So if I did convert to poz my costs would be covered.  I certainly didn't mind a premium to not get HIV in the first place.)  

About two hours after that they called back with a plan; Descovy for $0 copay.  So I was pretty happy they found a way.  My meds are mailed to me once a month and all I have to do is verify receipt in their system and it'll keep coming.  I am grateful I went, and while there were a few hours of doubt that I would be able to get back on PrEP; I wasn't in a panic about it.  

[Rickindc]

Apart from price concerns, we may have to worry about supply issues. I started Descovy last year, but since December, applications to be renewed in the [national program] have been backlogged. Thus, I am going without, and I assume others are facing the same problem.

[ytowndaddybear]

If you have health insurance in the USA it must cover PrEP and all related Dr. appointments and lab tests; this has been the law in the United States since January 2021.

PrEP only protects you from HIV not any of the other sexually transmissible diseases, so if you want to stay HIV negative get on PrEP.

[think before following links] [think before following links] [think before following links] https://www.poz.com/article/insurers-must-cover-prep-related-services-prevent-hiv

Edited July 24, 2022 by ytowndaddybear

[Danthebttmman57]

It takes persistence and assistance to get PReP and HIV treatments at a reasonable cost.  Plus it can all change do to politics at a drop of the hat. 

My spouse and I are off meds by choice at this point. Keeping a close watch on the politics of HIV. Remember the Republicans would rather see you die than the government or insurance cover you. 

[BootmanLA]

11 hours ago, Danthebttmman57 said:

It takes persistence and assistance to get PReP and HIV treatments at a reasonable cost.  Plus it can all change do to politics at a drop of the hat. 

The first sentence is partially true. Yes, you have to go to a doctor to have either PrEP or HIV treatment prescribed - they don't just dispense it in vending machines. Yes, you have to either have insurance coverage, or participate in a program designed to make those costs reasonable. But getting a doctor's appointment for these things is not particularly complicated in the U.S., at least, and in most states, there are health office workers whose job it is to assist you in getting coverage under the program. When I first got coverage for HIV treatment, the person assisting me literally filled out the forms as I answered the questions he asked, and he clarified anything I didn't understand along the way. It literally could not have been easier.

As for the second sentence, that's really not true. Regulations can change, of course - one of the characteristics of the previous administration was its ham-handed attempts to overturn existing regulations by executive fiat, and the courts repeatedly striking those changes down because there is an established procedure for changing regulations, involving public comment, hearings, and the like. A more competent administration could probably have accomplished far more along those lines, but Hair Furor prized loyalty over competence every day of the week, and as a result, much of what he tried to do never got off the ground. (Caveat: there is a big apparatus being built among conservative groups with plans to "hit the ground running" if Trump or another Republican is elected in 2024, aiming to avoid all those missteps.)

Under the ACA, the federal government is charged with identifying and rating preventative health care services based on effectiveness. If a service gets an "A" rating, then it must be provided at no cost under most health insurance plans. In order to change that, a future GOP administration's DHHS would have to reduce that rating, and if they tried, that would almost certainly result in a court challenge to provide evidence that the change was warranted. And I just don't think that is possible - the evidence is what it is.

But even so, statutory law doesn't change at the drop of a hat. As we've seen, only certain fiscal items can get through the Senate with a bare majority vote; everything else takes 60 votes to break a filibuster, and changing something like gutting funding for HIV treatment isn't going to get 60 votes in the Senate, period.

11 hours ago, Danthebttmman57 said:

My spouse and I are off meds by choice at this point. Keeping a close watch on the politics of HIV. Remember the Republicans would rather see you die than the government or insurance cover you. 

Your choice, but understand that if things DO change as you fear (I think it's unlikely), it'll be that much harder to get onto meds if you reach the point where they're needed to keep you alive. I don't disagree that many GOP people would be content to see HIV+ die rather than give assistance, but I don't think even all of them would vote to end a program like Ryan White.