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HIVhilarity11
Newbie

Reged: 11/08/11
Posts: 4
Loc: NJ
Paying for Meds
      #258884 - 11/11/11 02:10 PM

Hi Everyone

I really need some help, advice, assurance. I'm very upset right now. My Husband and I were both diagnosed poz last Tuesday 11/1. We had our first appointment with the Infectuous Disease Specialist office yesterday and they were amazing. We are very lucky.
HOWEVER....we're likely about to hit a wall with ADAP. My Husband is a teacher and our nurse explained most teacher's insurance's are very fickle when it comes to hiv med prescriptions.
We are a 2 person household. We struggle to pay our bills like most people these days and my husband took on extra work (in addition to my odd jobs here and there) to make more money. This is putting us past the cut off for the 2 person income mark.
Why don't they consider that there are 2 of us needing meds though. Why don't they consider the significant amount of money my husband pays each month in child support. Or will they???

To top it all off my case manager just called to say I am likely going to be covered by ADAP. But most likely, my Husband is not. I was at work and couldn't really talk to him much more but it felt like I was punched in the stomach, Part of me wants to be happy I'll be covered but I can't because what if he wont be.

Are there ANY other options? If so what could we be looking at financially here?

I'm so scared.

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kicker
Moderator

Reged: 10/25/10
Posts: 1131
Loc: GA, USA
Re: Paying for Meds new
      #258886 - 11/11/11 05:21 PM

Your doctor should have explained to you that they need to get run a few tests before they even start you on any medication. It may be that you don't need to start immediately. So you are kind of putting the cart before the horse here.

Second referring to a nurse about what meds your husbands medical insurance will and will not cover is not the smartest move. What you should do is call the insurance company and ask what is covered and what isn't. Also ask them how you appeal to have a drug covered. Also I would ask what the co-pays would be.

Third, the drug companies offer a reduced rate for people who don't fall under ADAP because they make to much. They have guidelines and most offer a sliding scale as far as assistance. Again you would have to wait to see if you are need of medication and what kind of medication you will need before contacting them.

If your viral load is low and your CD4 is high there is no reason you will need meds yet in most cases. So try to calm down and not worry about it till you need to.

Your doctor should have drawn some blood and tested for the strain to see if it was resistant to any medication and also tested your viral load and cd4 at least before starting any medications. If he/she hasn't then you need to ask them to do so BEFORE prescribing meds for the best possible outcome. The results usually take about a week or two to come back. Then if it is decided you need meds you have some time in most cases to find a solution to your problems. It's not like you are hospitalized and dieing.

I realize this is all new and stressful, but worrying and panicking about things that aren't before you yet is only going to make you sicker in the long run. So try to relax and deal with it as it comes not before you even know there is a need to.

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TexasPOZ
Newbie

Reged: 11/22/11
Posts: 5
Loc: San Antonio, Texas
Re: Paying for Meds new
      #259131 - 11/22/11 02:48 AM

I was a teacher when I was diagnosed and my insurance paid for my meds. What's a nurse doing telling you what your health plan covers anyway? I've never heard of an insurance plan not covering HIV medications. Educate yourself by calling your insurance company and finding out for yourself. Get the facts and don't worry. It's good that you have a case manager, but remember if the one you have isn't working for you, you have the right to find another one. Take charge and be the one fighting for what you need to deal with this disease. I suggest finding a support group if there's one in your area and finding a good, sympathetic therapist to help you through the difficult time you're going through. Best wishes for you and your husband.

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Cruhaven
Member

Reged: 11/22/11
Posts: 10
Re: Paying for Meds new
      #259457 - 12/14/11 09:35 AM

It is expensive. States are cutting back on everything. Atripla is $3000 per MONTH...try affording that on $10/hr. I know that it is tough out there, everyone wants $$ before they even talk to you. Doctors scribe drugs without the realization that $3000 a month is hard and some people like myself can not afford that, even with subsidies from the state. You either need to be dirt poor without shelter to get help, or a self made millionaire to afford the drugs. The average in-between middle class is completely ignored. I feel your pain and hope you can find a solution. i am still looking. I am at stage 4 and life expectancy without treatment is less than a year. I am beginning to look at suits.....

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