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The cost of HIV meds under the ACA
Mar 28, 2014

I had asked a couple of months ago if it was true that my med cost would go up to %25 of the cost of the medication under the ACA. I was told that the costs should go down. Unfortunately that is not the case if you DO NOT HAVE Co-Pay assistance with the pharmaceutical company's. Your med cost will be 25%, at least it is with BCBS NC. When I tried to fill my first order of meds with my new "affordable" insurance I was told that my co-pay was $3630.65! I almost drove off the road. Once I had all my copay cards and made sure that the co-pay assistance cards were properly inputted into the system the cost went way down to $42 total. It took a month and many hours on the phone to get this rectified and went few days without meds and trust me BCBS was not happy at all to help. (I did get a supply from my clinic to hold me until BCBS got their stuff together) Please, please, please tell people that they need these co-pay cards or at least they do in NC. Most cards are easy to get online but others seem to be more difficult so you'll need to ask your health care provider or nurse for the difficult ones (norvir was the hardest one to get). I truly hope that this will help someone who doesn't about the copay assistance cards and I hope you all will maybe post links to the cards. Thank you!

Response from Mr. Chambers

Thank you for the reminder. Dealing with health insurance under the new system, although helpful for those who were without insurance, can be a bureaucratic nightmare. Not only are you dealing with a huge government bureaucracy, but you are also dealing with insurance companies whose first concern is their profits rather than your health.

It is very important to know as far in advance as possible what insurance and other sources are going to pay and what you will be left to pay out of pocket.

One of the major difficulties here at the start of this huge new program is figuring out not only what plan to join, but finding out which plans contract with what doctors and what medications are covered under each plan's formulary as they vary considerably.

This should be done, if possible, before joining a plan.

Also, be aware (and apply for) additional assistance that might be available such as the AIDS Drug Assistance Program (ADAP) and Patient Assistance Programs from the medication manufacturers.

If you catch yourself thinking, "They probably do it this way.." or "I just assume.." then think again. Assumptions can be devastating when it comes to health insurance because they are often wrong.

The advice you have given is very helpful and I encourage readers to pay attention to that as well as my reply.

Thank you again, Jacques



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