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I can only afford one of the three meds
Sep 21, 2011

I just found out I am in the "donut hole" of Medicare and can't afford the $1,000. co-pay Blue Cross and Blue Shield is asking me for my anit-virals: Epivir, Isentress, and Kalepra. I can afford to pay for one....which one should I purchase? I have been HIV positive for nearly 30 years and with meds, I have a viral load of 60. One month off of meds though landed me in the hospital last month with meningitis and a viral load of 50,000. The doctor gave me enough medicine to get me through this month. I am looking into other areas of resources, but so far have found none. Your suggestions are most welcome. Thank you in advance! Kris

Response from Dr. Young

Hello and thanks for posting.

Your's is a difficult situation. First and foremost you should not, definitely not, take just one of your medications. Especially not lamivudine (Epivir) or (raltegravir) Isentress, since both have low genetic barriers and HIV could easily generate drug resistance with monotherapy. There would be considerable risk of developing additional drug cross resistance and jeopardy of loosing even future treatments.

You've not mentioned what your CD4 count is,but discontinuation risks would depend much on your current (and lowest-ever) count.

As for how to pay, I'd check in with all of your resource- these include your doctor and pharmacist (sometimes it's possible to get your medications early), copayment assistance programs (for each of the drug companies) and AIDS service organizations (some have drug banks for just this purpose).

In the end, perhaps sadly, this is a teachable moment that reminds all of us to look carefully at our insurance benefits package and make sure that we save for the inevitable donut hole in coverage.

Good luck and good health to you, BY



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