The Body: The Complete HIV/AIDS Resource
Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol
Ask the Experts About

Workplace and Insurance IssuesWorkplace and Insurance Issues
Rollover images to visit our other forums!
  • Email Email
  • Glossary Glossary

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.



  • Email Email
  • Glossary Glossary



This forum is designed for educational purposes only, and experts are not rendering medical, mental health, legal or other professional advice or services. If you have or suspect you may have a medical, mental health, legal or other problem that requires advice, consult your own caregiver, attorney or other qualified professional.

Experts appearing on this page are independent and are solely responsible for editing and fact-checking their material. Neither nor any advertiser is the publisher or speaker of posted visitors' questions or the experts' material.

Review our complete terms of use and copyright notice.

Powered by ExpertViewpoint