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Insurance and Prescriptions
Sep 27, 2012

Hi, Both my partner and I have been recently diagnosed with HIV and after seeing a specialist we found that the medication that was prescribed is very expensive. He has insurance and I had recently gotten insurance just before testing positive... If both plans provide prescription coverage are medicines like Stribild and Atripla covered? Do they fall under a certain category that we can research? If they are covered, what can I expect to pay out of pocket? And lastly, if they are not covered, What can I do to pay for them? We, Would really appreciate and information you could give us and we hope that this might help someone else.

Response from Mr. Chambers

The medical classifications of medicines are not determinative of what tier the insurance plan places them in. Each insurance company decides what to cover and what copay to charge for it. You would need to ask your insurance companies to know what is covered and how much you will pay. Some insurance plans list their drug formularies on their website, so you may want to start there.

You should also connect with the AIDS Drug Assistance Program (ADAP) in your state. You may reach them through a local AIDS Service Organization. These are federally (and state in some cases) funded programs that pay for medications and supplements insurance plan payments so you pay little or nothing for covered medications. ADAP programs vary dramatically by state. Some cover many drugs; others cover very few. Some have waiting lists for coverage.

They all have income criteria for eligibility, but it is usually fairly high, e.g. $50,000 per year or less.

Good luck, Jacques



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