Truvada

[leanbtm]

Makes sense that they don't want to cover 90 days. If you fail on the medication or stop for any other reason, it reduces their loss.

Unless of course you are one of the tens of thousands of people that have been successfully taking it for years for hiv infection, then not so much.

[Rudynate]

Unless of course you are one of the tens of thousands of people that have been successfully taking it for years for hiv infection, then not so much.

 

 

 

We're talking insurance carriers. I also think they adopt business practices that are designed to make taking a medication more inconvenient, like requiring a monthly refill on Truvada. Anything to make the medication harder to prescribe.

[+ sniper]

Well there's also the fact that since in this country insurance follows the job, they run the risk of paying an extra couple thousand dollars they don't collect any premium to offset if the person picks up his 90 day supply then quits his job the next day. They do this with just about all similarly expensive drugs. They let you get 90 day supplies when the drug is cheap enough that the savings on transaction costs offsets the risk of paying a claim they weren't actually on the hook for.

[TruthBTold]

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason write that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.

 

As with any other medical information you receive here, you should speak with your physician before changing your behavior or regimen, particularly regarding HIV. My purpose was simply to provide information that was different than that usually provided and that that I did not know about. Moreover, it was from a person who I believed was a competent source. My doctor has worked with HIV/AIDS patients in a large city for the last 30 years or more. But PLEASE consult with your physician prior to any change in your regimen.

Edited May 25, 2019 by TruthBTold

[TruthBTold]

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason write that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.

 

As with any other medical information you receive here, you should speak with your physician before changing your behavior or regimen, particularly regarding HIV. My purpose was simply to provide information that was different than that usually provided and that that I did not know about. Moreover, it was from a person who I believed was a competent source. My doctor has worked with HIV/AIDS patients in a large city for the last 30 years or more. But PLEASE consult with your physician prior to any change in your regimen.

Edited May 25, 2019 by TruthBTold

[SirBillybob]

Hi, TruthBTold, I still think that what you described in more detail remains inconsistent with the guidelines for on-demand as I understand them.

 

I say this in the spirit of longstanding townhall-type sharing traditions for gay men since the onset of HIV, traditions that have made their way into current fora such as this one, and are like an unstoppable train.

 

The explicit proviso being such contributions do not stand in for properly sourced medical advice.

 

Not to be controversial or out-of-turn authoritative, or erode your confidence in your health provider.

 

The product monograph or pharmacist's instruction sheet is another means of ascertaining the correct regimen based on whether it is continuous daily PrEP or a current on-demand option endorsed in your particular country.

[wbtravis]

"...more than $1500 per month" is horrendously exploitative and very damn expensive. I found this out last month when I got my monthly supply. I am getting my meds prescribed through a superb agency in San Francisco although I live in another city and county in California. ...have insurance but did not want to go through lots of changes and am not using.

 

My meds are paid for via Gilead, I think. The assistant at COSCO brought me my big blue pills and told me they would be $1800; I looked and thought, "what happened." He did a double or third check and relayed that he'd forgotten the certificate or coupon. Afterwards, I left w/o having to fork up a dollar.

 

We who use this firm in "The City" are truly, truly, truly fortunate. I know I don't have that type of money to pay for any medication, especially for a meager monthly supply.

 

I would love to know more. I cannot put it on insurance. Do not qualify for free, per SF City Clinic. They gave me info to buy generic overseas for $80 (90 day supply), but it’s been three weeks of navigating and drug is still in transit.

 

Almost gave up!

[+ keroscenefire]

I would love to know more. I cannot put it on insurance. Do not qualify for free, per SF City Clinic. They gave me info to buy generic overseas for $80 (90 day supply), but it’s been three weeks of navigating and drug is still in transit.

 

Almost gave up!

 

Gilead does provide rebates/reimbursements for the drug. It honestly is kinda challenging and there are a lot of hoops. I've had to do it twice at the beginning of my insurance coverage when I haven't gotten close to my deductible on my insurance. You basically have to apply for the program then put it on a credit card, then do some paperwork to get it reimbursed and hope and pray that your check comes back before you start accruing interest. It did for me one time, but didn't the second time because I had paid for it partially through an HSA and I guess they don't reimburse those. They did reimburse the portion that I paid on my credit card, but I had to like go through my credit card statements and highlight the Truvada payment and by the time I got the rebate I had acquired a couple hundred dollars in interest that Gilead would not pay.

 

Trying to get a hold of them on the phone was a nightmare and they required faxing and mailing documents, which is kinda insane in this age of e-mail. But at least for me it was kinda worth it because one 90-day supply actually met my entire deductible and after that I basically had to pay little or no money for any medical treatment at all until my insurance renews for the year.

 

Anyway the web site is here: https://www.gileadadvancingaccess.com. Good luck on trying to figure it out. They don't make it easy but maybe the SF City Clinic has some resources to help you with it (my insurance company did for me).

[Rudynate]

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason wrote that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.

 

As with any other medical information you receive here, you should speak with your physician before changing your behavior or regimen, particularly regarding HIV. My purpose was simply to provide information that was different than that usually provided and that that I did not know about. Moreover, it was from a person who I believed was a competent source. My doctor has worked with HIV/AIDS patients in a large city for the last 30 years or more. But PLEASE consult with your physician prior to any change in your regimen.

 

 

I suppose if someone is given to side effects, or their renal system can't tolerate daily dosing, the on-demand protocol might make sense. But other wise, why would you risk confusing yourself with a complicated dosing algorithm?

I would love to know more. I cannot put it on insurance. Do not qualify for free, per SF City Clinic. They gave me info to buy generic overseas for $80 (90 day supply), but it’s been three weeks of navigating and drug is still in transit.

 

Almost gave up!

 

 

Dont give up. I get mine from off shore. You have to be sure to reorder when you about a months supply left. It works fine.

[wbtravis]

I suppose if someone is given to side effects, or their renal system can't tolerate daily dosing, the on-demand protocol might make sense. But other wise, why would you risk confusing yourself with a complicated dosing algorithm?

 

 

 

Dont give up. I get mine from off shore. You have to be sure to reorder when you about a months supply left. It works fine.

Awesome. Yes, getting the first order was painful. My credit card would not process because shipping address was different than billing. Tried to sign up for Bitcoin - major pain in the ass. Bank transfer didn’t work either. Ultimately- friend used his Am/Ex for me. Now i’ll reorder when I am down to one month remaining. My challenge is all about keeping this off the grid, but I imagined a lot of guys would give up.

 

Thanks for the encouragement!

[wbtravis]

Gilead does provide rebates/reimbursements for the drug. It honestly is kinda challenging and there are a lot of hoops. I've had to do it twice at the beginning of my insurance coverage when I haven't gotten close to my deductible on my insurance. You basically have to apply for the program then put it on a credit card, then do some paperwork to get it reimbursed and hope and pray that your check comes back before you start accruing interest. It did for me one time, but didn't the second time because I had paid for it partially through an HSA and I guess they don't reimburse those. They did reimburse the portion that I paid on my credit card, but I had to like go through my credit card statements and highlight the Truvada payment and by the time I got the rebate I had acquired a couple hundred dollars in interest that Gilead would not pay.

 

Trying to get a hold of them on the phone was a nightmare and they required faxing and mailing documents, which is kinda insane in this age of e-mail. But at least for me it was kinda worth it because one 90-day supply actually met my entire deductible and after that I basically had to pay little or no money for any medical treatment at all until my insurance renews for the year.

 

Anyway the web site is here: https://www.gileadadvancingaccess.com. Good luck on trying to figure it out. They don't make it easy but maybe the SF City Clinic has some resources to help you with it (my insurance company did for me).

Thanks much!!!

[Rudynate]

Awesome. Yes, getting the first order was painful. My credit card would not process because shipping address was different than billing. Tried to sign up for Bitcoin - major pain in the ass. Bank transfer didn’t work either. Ultimately- friend used his Am/Ex for me. Now i’ll reorder when I am down to one month remaining. My challenge is all about keeping this off the grid, but I imagined a lot of guys would give up.

 

Thanks for the encouragement!

 

 

I found the best way to pay is to use an e-check.You fill out the e-check on the vendor's website. The vendor submits the e-check and the funds are paid directly out of your checking account. The last time I ordered, I paid with Bitcoin. There are probably better ways to buy BTC, but I buy it from a BTC ATM at a shopping mall near my house. I deposit the cash, and the BTC ATM automatically deposits the BTC to my wallet. You can access your wallet from your phone, your desktop computer or your tablet. It's about as complicated as using Paypal.

[wbtravis]

Wow. GREAT tips! Thank you:)

[josh282282]

As suggested I did go back and checked about the information my physician gave me. I did make a huge mistake when I wrote what he had told me. What he told me was that the efficacy of daily dose Truvada is equal to taking a single dose for 2 days before intended sexual activity followed by a single dose for one or two days after sexual activity takes place. I for some reason write that a single dose for two days before was sufficient and equal in efficacy. That was a very serious misquote and I am sorry for it.

 

OMG, you STILL have it so wrong!

 

That is not the correct dosing schedule at all. It is not taking "a single dose for two days", its TWO tablets 2-24 hours before sex followed by a single tablet 24 hrs after the first two-tablet dose, then the final dose 24 hours after the previous dose. Yes, exactly that schedule. The way you wrote it, it's wrong and sorta haphazard. On-demand (or Event dosing) can work, but the margin for error is very small. That's why it is not the standard of care everywhere. A person has to have his game ON without error in order to have sufficiently high plasma levels in order to prevent HIV infection if exposed. Wrong dosing and haphazard is a great recipe for getting infected.

 

You are a perfect example why the On-demand schedule is not the standard of care: some people cant listen to instructions sufficiently. Therefore just instructing you, and others like you, to take it every day might work best in preventing infection. But, On-demand PrEP does work, it just has its risks, which the studies informed about (but most people dont want to acknowledge).

 

Once again, I fear some reader of this website to see what you wrote, (incorrectly) do how you said, and then get HIV infected. Yes, sad, huh. But very possible given how important timing is with On-demand PrEP: all you have is 4 (four) tablets to prevent transmission with that guy you just barebacked with. That's not a lot of tablets (or wiggle room) to get enough drug in you to prevent HIV transmission. For the guy really wanting to stay HIV neg, following the correct dosing schedule is ever-so-imperative. Anything less reduces the serum concentration and increases risk of transmission. I fear you miss all this.

 

So might others.

 

How sad.

 

Go back to your doctor. Review the correct dosing schedule. Be diligent. Make sure. Stay HIV negative.

 

And for all others reading my notes here on this topic regarding PrEP, always be careful how you talk about medical issues. Sometimes (um, more like often) as I counsel, educate and instruct a patient in my exam room I have to carefully dispel odd, inaccurate medical ideas he "read somewhere" (like M4M Message Forums). Its these inaccurate ideas that prevent a patient from accepting a really critical medical intervention I'm trying to persuade a patient to accept. Really guys, possibly the number one hold-up of a patient accepting care is their wrong ideas which they got online or from a friend. PLEASE, help out your friends by not contributing to this issue. In this particular issue, wrong information can lead to someone getting HIV.

 

I wish all nothing but the best and good health.

[+ sniper]

I suppose if someone is given to side effects, or their renal system can't tolerate daily dosing, the on-demand protocol might make sense. But other wise, why would you risk confusing yourself with a complicated dosing algorithm?

.

 

Eh, I could see people who have sex extremely sporadically, like, say the many married-to-a-woman men who only dabble when at their annual trade show in Vegas, finding that a better option, not just for side effect risk, but to lower risk of being discovered by their regular partner...

[+ BenjaminNicholas]

Jesus Christ. This is ridiculous.

 

Dr Benjamin suggests taking one pill a day. Simple, effective and the most surefire way to medicinally protect yourself against HIV. Why the hell do people need to needlessly complicate this and, clearly, not understand the correct 'on-demand' dosing?

 

Yeah, there are exceptions to the rule, but for most people, one pill a day works.

[Walker1]

Interesting about generics from overseas. Do they follow FDA policies and/or atleast from some nation with strict medical guidelines?

[SirBillybob]

OMG, you STILL have it so wrong!

That is not the correct dosing schedule at all. It is not taking "a single dose for two days", its TWO tablets 2-24 hours before sex followed by a single tablet 24 hrs after the first two-tablet dose, then the final dose 24 hours after the previous dose. Yes, exactly that schedule. The way you wrote it, it's wrong and sorta haphazard.

 

----

Yes, correct dosing is essential.

 

Dosing depends on the timing of sex and whether sex is just once in the event-driven cycle. See the instructions as I described earlier in this thread.

 

In many cases it would be 5 doses for one episode of sex.

 

If sex is planned for Tues evening, and it is known far enough ahead, then logistics dictate two doses together (double dose), say, Mon 10 PM, one dose Tues 10 PM, one dose Wed 10 PM, final dose Thurs 10 PM. This dosing schedule follows the dictum of one dose daily, following the double dose, until 48 hours after the last sexual activity.

 

Ideally, one might keep the Tues evening dose in the condom drawer.

 

If it is a slumber party with another go on Wed morning, the final dose remains Thurs evening because 48 hours after last sexual activity is Fri morning. Because I am infrequently sexually active my own quirky style would likely mean throwing in an additional dose Fri evening, for good measure.

 

Personally, for on-demand event-driven, the scheduling has always involved a minimum of 5 doses.

 

Parenthetically, if sex occurs every Tues evening, the daily regimen might be more appropriate. However that is often not the case.

 

There is some research on preferences piggy-backed on the clinical studies. A closer look can be found at aidsmap.com or poz.com

Zimmerman H et al ... PrEP MSM ... motives to choose, switch, discontinue event-driven and/or daily.

Edited May 27, 2019 by SirBIllybob