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HIV treatment and Federal Health Benefit Insurance Providers
Nov 22, 2013

I was recently married and am now able to include my partner in my FEHB insurance coverage. When comparing plans for open enrollment, can I assume that the co-pay information provided for brand name prescription medications will also apply to his HIV medication?

Response from Mr. Chambers

You are correct. They cannot single out HIV medications for higher fees.

However, most health plans, including most offered under FEHB put medications in tiers with different co-pays. As you might imagine, most HIV medications, especially the newer ones, will be in higher tiers which will have a higher co-pay, some may even charge a percentage of the retail price instead of a co-pay.

See if you can get a copy of the plan's formulary to see which tier the medications are in....or you may find it at the carrier's website.

And, of course, depending on where you live and your household income your spouse may qualify for AIDS DRUGS ASSISTANCE PROGRAM (ADAP). You can find out more about that through your nearest AIDS Service Organization.

Good luck, Jacques



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