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donut hole
Jan 11, 2012

I am a 33 year old HIV positive male treated on atripla and have been covered by private insurance at my job. However, my HIV medicine has reached a lifetime cap on being paid for. Even with the atripla co-pay card, I still have to come out of pocket $850/month. I make around $35,000/year so therefore I am not eligible for ADAP or Ryan White. I cannot afford $850/month for my meds and be able to pay rent, utilities, groceries, etc. Are there any options I'm not looking at? I mean how does Joe Blow middle class American afford his HIV medicine when insurance caps out?

Response from Mr. Chambers

There are several things you can try, although I can't guarantee which, if any, will be successful. First, I would doublecheck your eligibility for ADAP. $35,000 per year is low enough to get some assistance in most states. It's not clear from the letter about your lifetime cap. If it is just for your HIV medications, that is considered discriminatory in all jurisdictions and you may want to contact a local AIDS Service Organization or legal services agency to see if such a cap is legal. If it is for all medications, that limit will be phasing out as the Affordable Care Act takes effect.

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