Truvada Track - monitoring insurance and Medicaid coverage of Truvada for PrEP
NEW - Click now for AIDS Foundation of Chicago's just published (November 2015) PrEP coverage guide for IL health marketplace plans. The document contains information on the estimated monthly out-of-pocket cost a person can expect to pay for Truvada as PrEP under each of the plans on the Illinois health insurance marketplace offered in Cook County. When taken consistently and correctly, PrEP can reduce one’s risk of contracting HIV by close to 100%.
We are more than happy to help you advocate for access should you be denied a PrEP prescription from your healthcare provider or denied coverage from your insurance company or Medicaid.
Send us an email to email@example.com with as much information as you can. If you can send a copy of the actual denial letter or any official communication - better!
We have found that the vast majority of denials are reversed by submitting an appeal. Don't take "no" for the final answer here. Sometimes a squeaky wheel is necessary to access PrEP. We can help.
This is a great resource guys! Have been looking for this information as I will be shopping for health insurance soon and was wondering if they are covering it and how does it work. thanks!ReplyDelete
Glad this is helpful! Keep us posted!ReplyDelete
any info on Indiana?ReplyDelete
On the phone with Aetna as I type this trying to get our co-pay of $910/month each to something more affordable. This sight has given me some terminologies I can use to try to argue my point. Thanks!ReplyDelete
I have a high deductible plan. After finally finding a doctor to prescribe the PrEP, I have to meet a $1300 deductible before it's covered. I live paycheck to paycheck so I can't even do one month to meet the deductible.ReplyDelete
I am in a similar situationDelete
Did you see the handy chart noted in the article above this section? There is a flowchart that walks you through various options on what assistance you may be able to get based upon your situation. There is assistance from Gilead for co-pays that may be what will fit your situation. Hope this helps.Delete
What doctors/agencies in NJ and surrounding area are prescribing PrEP?ReplyDelete
Whatever you have provided for us in these posts really appreciative.httarlislReplyDelete
My insurance had a pre-authorization form for Truvada. When they denied the pre-auth, it was denied because it was being used for PrEP and not treatment. I do not qualify for the Gilead programs. Is there another path I can take or am I stuck with $1800/month out of pocket?ReplyDelete
I am on Disability & have a Medicare Advantage plan. Truvada is a Tier 6 drug which I must pay 33% copay, which is appx $300+ per month. I got assistance from PAN which will almost cover the co-pay, at least make it where I could afford what isnt covered on the co-pay. Here is the problem. Within a short appx 3 months of insurance coverage & my co-pay it would send me into the med gap & insurance would stop paying any coverage for meds until I paid appx $5000 out of pocket. So even with the help on co-pay I am forced out of the option to obtain Truvada. Is there any way out of this or programs that can help?ReplyDelete
I work for a Fortune 50 company with company provided health insurance. The drug coverage for Truvada requires pre-authorization. I have found that it is only covered for treatment of HIV infection and not for pre-exposure. I have been through two appeals with clear denials on both. I do not qualify for any of the assistance programs that I have found so far. What are my options?ReplyDelete
What is your insurance carrier? While some carriers require pre-authorization, we know of none who are simply not covering Truvada as PrEP. It could be your doctor may be using improper diagnosis and treatment codes - s/he can check this document to make sure http://www.cdc.gov/hiv/pdf/PrEPProviderSupplement2014.pdf. We highly recommend appealing again - the squeaky wheel usually wins on these things.Delete
The insurance carrier is United Healthcare. They are not the ones who set what is covered however. It is all done through the employer. I have spoken with Senior HR officials as well as gone through the complete denial/appeal process and have had no luck. The insurance pre-authorization denial is clear that they will not cover Truvada for PRE-exposure, only in case of actual HIV infection.Delete
So I had Blue Cross and was on Truvada. I switch jobs and now am on Aetna HMO- Open Access plan. My pre-auth was denied. My doctor said they were only approving it for people who were HIV positive. Any advice? My doctor is a Infectious Disease specialist so I would have hoped he'd have experience in this area. Any ideas?ReplyDelete
Caremark (Value) which was chosen by my Employer, will not cover when prescribed for prepReplyDelete
We have found that when people appeal, they are successful. We suggest appealing.ReplyDelete
What is the recourse when you have had all appeals exhausted? If your income is more than 400% federal poverty, none of the assistance programs allow you to qualify. That leaves you with a bill of over $1300/month!Delete
I recently switched to Blue Shield in California and my co-pay is $15.00/mo. You can also ontact your local AIDS project or charity for information on which doctors/clinics to go to to acquire the medication.ReplyDelete