Are Your Out Of Pocket Payments For Medication Getting Ridiculous? | myHIVteam

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Are Your Out Of Pocket Payments For Medication Getting Ridiculous?
A myHIVteam Member asked a question 💭

I used to be on ADAP, the Government Drug Assistance Program for AIDS for years until I inherited a trust which changed everything. I no longer am eligible, making too much money which I get. I am enrolled in a MedAdvantage Plan with a major insurance provider I have with for years. They take care of all my Medicare expenses, plus provide me with some extras. We know we do not have any generic HIV drugs on the market here in the US that I know of, where most other countries do, so a big… read more

posted March 29, 2019
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A myHIVteam Member

you can go directly to the drug manufacturer's website. they have programs that will help pay some of the copays if you qualify. Have you tried that route yet?

posted April 28, 2019
A myHIVteam Member

Last year was my first full year on Medicare. I, like you am on other expensive drugs as a result of having HIV and taking HIV drugs. My January out of pocket cost for 3 prescriptions was just shy of $1,700. The Biktarvy alone was $998. I am fortunate to have a reimbursement account through my previous employer that will reimburse $2,700 annually, but if you go over $5,000 they start paying again. This helps a LOT! I have a pension & Social Security as income, and my house is paid for, so my debt to income ratio is nil, which also means that I'm "on my own" with all of this. It's as though the disease management business (other countries have a real healthcare system) and big pharma want to take everything from us, then dump us onto a government program. Our entire "medical system" is broken in this country and largely motivated by greed.

posted March 30, 2019
A myHIVteam Member

I'm very fortunate and grateful to have Medicaid and don't take retro virals.

posted December 26, 2019 (edited)
A myHIVteam Member

Jeff25, I'm finding that in each state that there are different programs available for folks that are having difficulties in paying for prescriptions. There are people that are unable to get any help at all, which makes me so angry because the funds are available. Due to the wording of each state & city, it makes almost impossible of many to get the funding of these programs. Sometimes you have to almost diasect the program to find a loophole in it. Try contacting the companies to see what help they can offer. Sometimes they have funds available. I'll see if there's something on my end that you may be able to use.

posted May 20, 2019
A myHIVteam Member

Thanks Charles for your response. I'm kind of caught in that income dilemma where I make too much to be on ADAP, and many times too much to qualify for drug company assistance. With Medicare cuts, and drug companies pushing up their prices at will, I'm really having to budget. I guess it may be different for many people, but currently my situation sucks.

posted May 18, 2019

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