HIV Meds Covered Under Insurance?

[Josh1959]

I’ve been diagnosed and undetectable since 2014. I’m about to begin Medicare in January. I’m really surprised that drug companies don’t offer discounts on copays when on Medicare like they do with commercial insurance. Today, I pay nothing as a copay. Starting in January, I’ll be paying $175 USD per month. This seriously cuts in on my social security funds.

Is this also your experience? I would say I am lower middle class, but this seriously stings.

[757pozzybear]

Are you also eligible for Medicaid or ADAP? That should help pay for the copay if eligible.

[Marlin]

1 hour ago, Josh1959 said:

I’ve been diagnosed and undetectable since 2014. I’m about to begin Medicare in January. I’m really surprised that drug companies don’t offer discounts on copays when on Medicare like they do with commercial insurance. Today, I pay nothing as a copay. Starting in January, I’ll be paying $175 USD per month. This seriously cuts in on my social security funds.

Is this also your experience? I would say I am lower middle class, but this seriously stings.

Is that your drug copay or your Medicare coverage copay. Everyone on Medicare has a fee deducted from their social security every month that has nothing to do with their prescriptions 

[Versholefun]

I’ve had the same Blue Cross coverage through employer for 20 years. Two years ago diagnosed with AIDS and prescribed Biktarvy with my copay being 530.00 per month.  January 2025 switched to Medicare with copay of 0.00 per month.

[PozBearWI]

Yes, starting in January I'll pay my max drug copay of $2,100.  After that I won't pay for any of my meds for the rest of the year.  For 26 my advantage plan is offering to spread the $2,100 out over the 12 months.  

[Nude]

Ryan White program.  You pay nothing for your meds.  [think before following links] https://ryanwhite.hrsa.gov/