Completely free PREP in USA

[Sfmike64]

Since earlier this year, the US government has required that PREP be completely free for every insured person. This means that not only do you get the medication for $0 co-pay, but your doctor visits and tests are completely covered as well. There should be NO copays or additional costs for these visits. If there are, your insurance company is doing it wrong.

This is how the rest of the world does it, but our obsession with "cost sharing" means that people have encountered cost barriers to care. This should go a long way toward reducing all of the barriers to taking PREP in the US.

If this has already been covered, my apologies.

[PigFaggot2904]

I recently resumed PrEP.  Because of this, I was able to get Descovy with $0 copay--I was shocked when I saw $0 on the screen, when I was ordering from my pharmacy website.

[Guest]

Nothing is free in this world. We are all paying for prep in higher premiums and shifted cost sharing in other products and services elsewhere in the system.

[Kimberley]

41 minutes ago, Jackruby said:

Nothing is free in this world. We are all paying for prep in higher premiums and shifted cost sharing in other products and services elsewhere in the system.

This 😂😂 every fucking year the healthcare insurance cost rises hahaha how would that be come

[Sfmike64]

47 minutes ago, Jackruby said:

Nothing is free in this world. We are all paying for prep in higher premiums and shifted cost sharing in other products and services elsewhere in the system.

While that's true, you're completely missing the point.

Which is to make out of pocket cost $0 so that people will actually go on PREP and not get infected with HIV which ends up costing more money to the entire health care system. 

[Kimberley]

11 minutes ago, Sfmike64 said:

While that's true, you're completely missing the point.

Which is to make out of pocket cost $0 so that people will actually go on PREP and not get infected with HIV which ends up costing more money to the entire health care system. 

they do it themselves. if somebody is HIV positive he gets the original Truvada for free that cost hundreds of euros more, why i asking myself?

[Sfmike64]

Because not treating HIV infection costs a massive amount more money than anti-viral drugs which are relatively inexpensive these days (particularly the ones that have gone off patent like Truvada). 

I can't believe I"m explaining all of this to you guys. Am I just a policy wonk? Or am I just old and watched all of this play out for the last 30 years?

[Kimberley]

2 minutes ago, Sfmike64 said:

Because not treating HIV infection costs a massive amount more money than anti-viral drugs which are relatively inexpensive these days (particularly the ones that have gone off patent like Truvada). 

I can't believe I"m explaining all of this to you guys. Am I just a policy wonk? Or am I just old and watched all of this play out for the last 30 years?

please, generic prep cost about 25 euro's and Truvada 500 euros

 

[Sfmike64]

Sigh. Fine. Be annoyed. I don't really care.

Your system is massively different than ours (and generally better, our health care system is a complete nightmare for many people). So comparing one to the other is ridiculous. My original post was about free PREP in the USA.

In fact, high US prescription drug prices (for all sorts of prescription  medications) subsidize those drugs in the rest of the world because our government is in the pocket of Big Pharma and its ability to negotiate drug prices is limited by law (Biden and other progressives are trying to get Congress to change this). 

You're welcome.

[fskn]

@Sfmike64, it's refreshing to see another reminder about the preventive health mandate, which makes PrEP care (visits, tests, prescription) free (no $ copayment or % coinsurance, and not subject to a deductible) for the vast majority of health insurance plans in the US.

I wonder why outfits like MISTR that purport to help with paperwork — some now unnecessary, in the case of drug manufacturer patient assistance rebates for PrEP drugs, and some now an illegal insurer requirement, in the case of preapproval forms — continue to advertise, and I wonder why people who are insured, or who are eligible to be, don't exercise their rights.

You are completely correct that the system cost of PrEP care is less than the system cost of HIV care for infections not prevented. People need to bear in mind that even though the preventive care designation makes PrEP free, prescribing guidelines do apply. PrEP is and has always been intended for groups who are at a statistically high risk of getting HIV, such as men who have sex with men (MSM), trans people, and especially people of color and young people. There is no intention that the entire US population be on PrEP. (In other countries, high-risk groups are different, of course. In many African countries, HIV is widespread among heterosexuals, which would make PrEP economic for the general population.)

I would offer a different explanation for high prescription drug prices in the US, which subsidize patient assistance programs here at home and subsidize low drug prices (or low licensing fees) in the developing world: Americans love the fiction of charity.

Our country has always been uncomfortable providing comprehensive health care to people who are not working, are not married, don't earn much money, are not citizens or permanent residents, etc., etc. Patient assistance programs, subsidized by full-price drug buyers such the federal government, the states, and large private insurers, have been more palatable than political change to establish universal health insurance. Voters who consider universal health insurance socialist, unamerican, downright horrible, feel good when they imagine that US drug companies are performing an act of charity by offering rebate coupons.

Similarly, we've always been uncomfortable helping foreign countries — especially if the residents look different than us or worship differently. (We're glad to help when we get something in return, like a pool of cheap labor, control over natural resources, or access to land for forward military bases.) Drug price discounts for developing countries have been more palatable than political change to increase foreign aid spending and ease restrictions (see "gag order", for example). The same voters who consider foreign aid abhorrent feel good when they imagine that US drug companies are performing an act of charity by giving away medicine (or the right to make and sell it) to developing countries.

I don't think the drug companies have the government in their pocket. I think they're responding naturally and logically to a political quagmire that leaves millions of Americans still uninsured and billions of people in the rest of the world still unable to afford essential medicines.

Patchwork "solutions" like patient assistance programs and foreign discounts do just enough that we as Americans don't have to see too many people dying on the street (I mean this in the sense of "without medical care", not in the sense of homelessness, which is a different problem handled in a similar way; my city has yellow parking meters where idiot do-gooders can insert dimes and quarters, ostensibly to "solve" homelessness!).

People like me who prefer system solutions like universal health insurance, domestically, and larger aid payments, abroad, are either in the minority, or we don't control enough votes (in institutions like the Senate where, the more populous the state, the less each person's vote matters).

Edited October 4, 2021 by fskn
Typo, missing word

[BootmanLA]

9 hours ago, fskn said:

I wonder why outfits like MISTR that purport to help with paperwork — some now unnecessary, in the case of drug manufacturer patient assistance rebates for PrEP drugs, and some now an illegal insurer requirement, in the case of preapproval forms — continue to advertise, and I wonder why people who are insured, or who are eligible to be, don't exercise their rights.

My guess is that it's one thing for an openly gay man in NYC, LA, SF, FTL, etc. to go to his doctor and ask for PrEP. It's another thing entirely if you live in a rural county in Mississippi, or Texas, or Alabama, or Wyoming, At least as of a few years ago, there were 35 counties in Texas (out of 254 total) that had ZERO physicians in the entire county, and quite a few others that had only one. While doctors and other health care professionals are bound by HIPAA not to disclose patient information, the reality is that in small towns, people gossip, and even if the fear of gossip is overblown, that can discourage people from seeking PrEP. Online services like MISTR, while not really a complete substitute for preventative care through a primary care physician, may be better than nothing.

[Sfmike64]

Anyone who is afraid to talk about their doctor about their actual risk of disease needs to get a new doctor. I'm absolutely not kidding. If you can't talk to your doctor about your medical issues then there are other, serious problems going on. Because you must keep monitoring things like your liver function while your'e taking anti-viral drugs. The medical tests are covered with no co-pay as well, but you must do them. 

There are other online services that can help you. MISTR isn't the only one. Web sites run by Gilead will point you toward doctors with experience prescribing these drugs.

Take control of your health. Be proactive about it. Don't just let stuff happen to you. So many people (including important people in my life) hate doctors. But I'm living proof that early detection of disease (in my case prostate cancer) means treatment is straightforward and not difficult.

If you're over 50, get a PSA test (so there is a baseline and have a test yearly...that's how they discovered I had cancer) and a have a colonoscopy. If you have a uterus, have a Pap smear regularly. Both women and men can get breast cancer. Get a mammogram if you are at risk (family history).  

If you're younger? Get the vaccine for HPV which prevents anal and throat cancers in men,  and  cervical cancer in women. You can do this up to age 45 now, which is much higher than previous guidance from CDC.

[BootmanLA]

1 hour ago, Sfmike64 said:

Anyone who is afraid to talk about their doctor about their actual risk of disease needs to get a new doctor. I'm absolutely not kidding. If you can't talk to your doctor about your medical issues then there are other, serious problems going on. Because you must keep monitoring things like your liver function while your'e taking anti-viral drugs. The medical tests are covered with no co-pay as well, but you must do them.

I agree, but.... as I noted, sometimes there simply aren't other choices, if you live in a rural area where there's only one doctor. Or no doctor, and you have to travel 30+ miles to get to the only one within an hour.

And yes, I know, that's a small portion of the gay community. It's just that for those people, if nobody else, options that let you bypass a locally gossipy medical presence are better than nothing. 

[Sfmike64]

You're right. But also,  anyone who finds out their doctor (or the doctor's staff) has been gossiping about them should immediately report those people to state medical boards. EVERYONE has a right to privacy about their medical care, small town or no. No one who works in a medical office should be talking about patient information and needs to strangers.

[BootmanLA]

Of course. But proving who blabbed could be a problem. Was it the doctor, someone in his office, or someone at the pharmacy who filled the prescription? If all you know is that people are talking, pinning down the source of the breach of confidentiality could be a problem.

And even if you figure it out - going after them, in a small town, could invite more trouble. If you get the beloved nurse in the local doctor's office fired because of a HIPAA violation, who knows how the locals will respond?

Again, I agree with what SHOULD happen - but real life in small communities tends to be a lot messier.