Medicare and Tivicay
Jan 15, 2014
It doesn't appear that Medicare currently covers Tivicay (dolutegravir). Is there any way to find out why that's the case? Could it be that it's simply working its way through some lengthy approval process or has Medicare already evaluated this medication and decided not to cover it? The latter possibility seems odd given how quickly after the FDA gave approval in 2012 to Stribild that Medicare included it in its formulary. Oddly, but thankfully, Tivicay is included in the ADAP formulary in such diverse states as California, Florida, Ohio and Arkansas.
Response from Mr. Chambers
The prescription medications under Medicare Part D are handled by private insurance companies. Each carrier creates its own formulary within the overall guidelines.
Medicare Part D plans are required to cover "all or substantially all" drugs in six specified classes, including antiretrovirals, however, it may be too new for your plan to have added it yet.
You should contact the carrier that handles your Part D coverage and see when they plan to add Tivicay. Also ask what procedure they have so your doctor can apply for an exception to get it covered while waiting for it to be added to their formulary.
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