WOW it has been so long since I have posted here! More or less that is due to my situation remaining somewhat stagnant up until this point. In the world, lots of announcements have been made as to the efficacy of using PrEP and they all point to the fact that PrEP is a valuable tool for anyone to have in preventing the spread of HIV. This is why I am always happy to speak out on behalf of PrEP as a prevention method, and also why I am an advocate for those trying to gain access to these important medications. The latter being the reason for my posting today.
First, a brief recap of my experiences in obtaining TRUVADA for use as PrEP up to this point. 439 days ago I was able to obtain a prescription and was able to get it free with the help of Gilead's Medication Assistance Program which covers the full cost of the medication to individuals who do not have insurance to help alleviate the cost. I had a very bare bones "emergency" insurance policy. (see my earlier post "Day 11: Jumping Through Hoops" for more details) Six months into my taking PrEP, I found out I was no longer covered under the Medication Assistance Program, because my Insurance would actually cover 50% of the cost of the medication. That still left me with a $500 dollar monthly co pay. Even after investigating Giliad's co-pay assistance program (more details on that soon) I found the Truvada would still cost me more than I could afford monthly. I then became the beneficiary of some very generous charity on behalf of my doctors. But I really did not like having to rely on that and wanted to get back to standing on my own two feet as far as providing for myself. Pride, as well as fear of that opportunity not being available were the big contributing factors in my investigating a new insurance plan when the marketplace opened back up.
My new healthcare plan went into effect on March 1st, 2015 and I finally got a chance to look up the costs of the medications. With my plan, it turns out monthly the co-pay for TRUVADA was going to be only $110. That is where I went back to Gilead's co-pay assistance program, which can be found at www. GileadCoPay.com. Gilead's Co-Pay assistance program will cover up to $300 a month for TRUVADA. Great! I thought I was set. However, as with everything else in this experience, I found this was not as simple as I had hoped. Gilead's program is simple to use and easy to access, my insurance, on the other hand, was more of a challenge to deal with.
United Health Care uses OptumRx for is prescription coverage. When I went online, I discovered that the only way to get Truvada covered with OptumRx was through their mail specialty pharmacy. When I called the specialty pharmacy, I learned they do not accept the co-pay assistance. I was so aggravated, the main reason I got this new insurance was to make sure I could afford PrEP. But then I talked to my partner, who I knew also had United as his healthcare. He told me that after talking to our local pharmacist, he found out he could opt out of the specialty pharmacy. So here's what to do if you find yourself in the same boat as me. There are a few ways to exercise your exemption right, online, by mail, or the easiest I found was making a phone call. 1-866-803-8570. Call up tell them you need to exercise your exemption right, they will ask you to choose one of two reasons you are opting out, privacy concerns, or timing and accuracy concerns with the delivery. After that, you will need to tell them an alternative in network pharmacy you would like to use. This pharmacy can be changed at any time, but you need to inform them of these changes. After opting out of the mail order, I was able to go to my local Walgreens, and use my co-pay assistance card. I am set, after once again jumping through a series of hoops.
Well, I think that's all I have for now. Thanks for reading, I know this update was long in coming! Please, as always, feel free to comment, or ask me any questions. Also share this with anyone or any groups of people who you think this would benefit. I hope you all are well, and I'll try not to wait so long until the next time we Talk about PrEP.
