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How Do I Get my Insurance to Pay for new drug?
Jan 3, 2006


I've been on Kaletra, Rescriptor and Viread for about two years now and was thrilled to find out about the new formulation of Kaletra. It would allow me to take it without food and without worrying about refrigeration, among other things. The problem is that my insurance will not cover it at a reasonable co-pay as it will with the previous formulation for Kaletra. They want me to pay half the cost rather than a $25 co-pay which comes to about $400/month.

What's your advice on getting them to cover the new formulation at the same rate as the old one? I can't afford it otherwise and it would make a big difference in my life. When I call, they just drone on about formularies and the like.

Thanks for any help you can give me!

Response from Ms. Franzoi

There is nothing you can do. It sounds like your prescription drug plan changed and it requires different co-pays from you depending on whether your Rx is generic, formulary or non-formulary. It sounds like your Rx is non-formulary resulting in a higher co-pay for you. Unless there is a formulary medication or a generic medication that your doctor can switch you to, you have no options under this plan except to pay the higher cost.

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