PrEP

[+ MostlyLurking]

A few days ago we were discussing the cost of Truvada. (I can't remember what thread it was or I'd post this there.) I just got my 30-day supply. I paid nothing, but Mr. Walgreen's reports, "Your insurance saved you $1924.99."

 

It wasn't my insurance, it was some kind of special program I don't know much about except that it pays. (Until June. Then I may be celibate until next January.) There probably aren't many people paying the full price. But the special programs and the other services won't cover everybody. For PrEP to be truly widespread, and for sure if it's to be adopted outside the rich countries, that price has to come down.

[TruthBTold]

Because it is a fairly new drug, I would imagine there is not a generic that can be dispensed. Then I believe the FDA can allow the manufacturer to retain another certain period for non-generic status. So it may not come down in price for awhile. I am not sure what happens when a patient needs a certain medication and there is no generic whether an insurance company has to cover it. Also, in cases like Truvada where a patient who is on PrEP whether that is considered necessary.

[MikeyGMin]

Funny you should mention this. I just got a letter yesterday from United Heath Care stating that Truvada used as PrEP will require a prior authorization. My experience with UHC has been that anything that retroactively requires a prior authorization is ultimately denied. It will be interesting to see how this turns out. Not like I don't already think health insurance companies are despicable and could hate them anymore, but this will certainly be one more thing to add to the "Why I hate health insurance companies" list.

[TruthBTold]

It will be a very odd situation because people (gay men particularly) generally wish to use Truvada as a preventative of HIV infection. It is to be used with condoms. Right now the "speciality" company I get my prescription from requires authorization before filling the prescription. However, as there is only one preventative use (of course it can be used by those who actually do have AIDS but obviously that is not for a preventative use) it seems so ridiculous to have to get pre-authorization. I always wonder what they are going to ask me, "Are you gay," "Are you having sex in circumstances that you believe there is some chance, no matter how slim, that you will be exposed to the HIV virus?" Why else would I get a prescription for preventative Truvada. They do not ask if I have already contracted AIDS.

[marylander1940]

A few days ago we were discussing the cost of Truvada. (I can't remember what thread it was or I'd post this there.) I just got my 30-day supply. I paid nothing, but Mr. Walgreen's reports, "Your insurance saved you $1924.99."

 

It wasn't my insurance, it was some kind of special program I don't know much about except that it pays. (Until June. Then I may be celibate until next January.) There probably aren't many people paying the full price. But the special programs and the other services won't cover everybody. For PrEP to be truly widespread, and for sure if it's to be adopted outside the rich countries, that price has to come down.

 

Because it is a fairly new drug, I would imagine there is not a generic that can be dispensed. Then I believe the FDA can allow the manufacturer to retain another certain period for non-generic status. So it may not come down in price for awhile. I am not sure what happens when a patient needs a certain medication and there is no generic whether an insurance company has to cover it. Also, in cases like Truvada where a patient who is on PrEP whether that is considered necessary.

 

There's already a generic but not on sale yet in the U.S.

 

http://www.thehindubusinessline.com/companies/cipla-gets-approval-to-sell-its-version-of-truvada-in-india/article8637483.ece

 

https://www.clearskypharmacy.biz/generic-truvada-tenvir-em-by-cipla.html

[Mydavid]

A few days ago we were discussing the cost of Truvada. (I can't remember what thread it was or I'd post this there.) I just got my 30-day supply. I paid nothing, but Mr. Walgreen's reports, "Your insurance saved you $1924.99."

 

It wasn't my insurance, it was some kind of special program I don't know much about except that it pays. (Until June. Then I may be celibate until next January.) There probably aren't many people paying the full price. But the special programs and the other services won't cover everybody. For PrEP to be truly widespread, and for sure if it's to be adopted outside the rich countries, that price has to come down.

I don't know if it is true. But I heard that if you began to take it, you should persist in it. If you stopped for a while, it wouldn't work well when you resume.

[+ MasssageGuy]

There's already a generic but not on sale yet in the U.S.

 

http://www.thehindubusinessline.com/companies/cipla-gets-approval-to-sell-its-version-of-truvada-in-india/article8637483.ece

 

https://www.clearskypharmacy.biz/generic-truvada-tenvir-em-by-cipla.html

 

Anyone have experience with ClearSkyPharmacy???

[marylander1940]

Anyone have experience with ClearSkyPharmacy???

 

no, but I buy from www.alldaychemist.com and also Cipla

 

[+ purplekow]

Preauthorization is a hoop put up by insurance companies to save money by having people who hate hoops give up without the care or the treatment they need. In this case, I believe the doctor will fill out a form which is a checklist of conditions for which the insurance company has agreed to pay. If you do not get the right checks, your doctor may call and after an interminable wait on the phone, he or she may plead your case. When i had my own office, I would have patient's who needed prior authorization come to my office and sit on the phone until such time as there was a person on the phone. The phone tree often required a lot of patient demographic information which the patient could handle and then, once the representative came on, I would get on the phone. Some may say that the patient should not be the one waiting on the phone, but the fact is, that with the number of preauthrizations required for testing, drugs, consultations some offices would need two or three people employed in order to perform this unreimbursed task. Some patient's came to realize that all you have to do is call them and they will approve it, a speech given by the insurance company, is in now way that simple. i dread to think what is going to be the case if the ACA is lost.

[+ sniper]

Is it also possible the pre-authorization is really a backdoor verification that it's you getting them and using them? Given the high cost of the drug, there's probably some concern about people using their coverage to get them for someone who lacks it, or stockpiling the pills to sell.

[MikeyGMin]

Is it also possible the pre-authorization is really a backdoor verification that it's you getting them and using them? Given the high cost of the drug, there's probably some concern about people using their coverage to get them for someone who lacks it, or stockpiling the pills to sell.

You obviously have a higher opinion of insurance companies than I do.

 

I don't hate the individual employees who work at health insurance or pharmaceutical companies, (everyone needs a job) but their executives are pure greed wrapped in blue suits. They have all of my medical records and I'm pretty familiar with data analytics. There is no way they don't already know that I'm a sexually active gay man.

 

I will jump through their hoops, but I know what their intent is, and that is to find a way to deny coverage. Fortunately my doctor is two doors down from the Austin PrEP Clinic who have been doing a fantastic job of supplying the medication to the community.

[+ BenjaminNicholas]

An interesting story on going the foreign generic route for PrEP. Clearly, there are still some hoops to jump through:

 

http://www.dailyxtra.com/canada/blogs-and-columns/prep-school/taking-gamble-with-generic-prep-191182

[maninsoma]

I don't know if it is true. But I heard that if you began to take it, you should persist in it. If you stopped for a while, it wouldn't work well when you resume.

 

I'm not a doctor, but that was my first reaction to the first post as well. I don't know that it's wise to start taking PrEP if you know you're not going to continue it.

[+ WmClarke]

I don't know if it is true. But I heard that if you began to take it, you should persist in it. If you stopped for a while, it wouldn't work well when you resume.

I'm not a doctor, but that was my first reaction to the first post as well. I don't know that it's wise to start taking PrEP if you know you're not going to continue it.

Do either one of you have any research to back up these assertions? No? Then don't post crap like this.

[rvwnsd]

I started researching Truvada as PrEP when covered by UnitedHealthcare and began treatment when coverage was switched to Anthem Blue Cross Blue Shield. UHC told me they required prior authorization because they wanted to verify that the HIV tests and liver enzyme tests were performed. Anthem does not require the prior authorization, but they will stop paying for the medication if they do not receive proof that the quarterly blood and urine tests are performed. They said they use the lab's claim as proof that the exam and tests were done.

 

Many of us remember the days when health insurance did not pay for prescriptions. There were no prior authorizations because there was no coverage. If you could afford to pay for a prescription you got it. If you couldn't you didn't. I'm not a fan of insurance companies, but I'd rather live with them than die without them.

[+ Gar1eth]

I don't know if it is true. But I heard that if you began to take it, you should persist in it. If you stopped for a while, it wouldn't work well when you resume.

 

That makes no biological sense from an infectious disease standpoint assuming you haven't been infected with HIV in the meantime. It is definitely false. Now they advise for safety that the full effect takes two weeks (although most likely protection kicks in before that), and so if you start up again you need another two week 'build-up period'.

 

Now if you are talking about from a side effect standpoint -I'm sure everyone is somewhat different. But most likely if you were tolerating it ok the 1st time without significant kidney, liver, or bone effects-then there's a good chance you will again. Of course it hasn't been out long enough to know the side effects for being on it for years.

 

Gman

[+ Gar1eth]

.

 

Many of us remember the days when health insurance did not pay for prescriptions. There were no prior authorizations because there was no coverage. If you could afford to pay for a prescription you got it. If you couldn't you didn't. I'm not a fan of insurance companies, but I'd rather live with them than die without them.

 

But of course the majority of medication costs in those days were nowhere near what new medications like those for cancer, monoclonal antibodies for rheumatic diseases, multiple sclerosis medications, diabetes medications, and etc cost today.

 

Gman

[maninsoma]

Do either one of you have any research to back up these assertions? No? Then don't post crap like this.

 

Well, after doing some research on line, you are right that I cannot find anything that would indicate that it's problematic to start PrEP and then stop it. The only argument I can find against it is that PrEP should only be taken by people who are HIV negative. If someone is recently infected but doesn't know that (and tests for HIV don't yet show the infection) and starts PrEP, he/she could be assisting their existing HIV infection to mutate to become resistant to the medications he/she is taking. So intentionally going on and off PrEP repeatedly might be questionable if that person is coupling the PrEP use with periods of high-risk activity.

 

I think your tone was unnecessarily aggressive, though.

[+ José Soplanucas]

Well, after doing some research on line, you are right that I cannot find anything that would indicate that it's problematic to start PrEP and then stop it. The only argument I can find against it is that PrEP should only be taken by people who are HIV negative. If someone is recently infected but doesn't know that (and tests for HIV don't yet show the infection) and starts PrEP, he/she could be assisting their existing HIV infection to mutate to become resistant to the medications he/she is taking. So intentionally going on and off PrEP repeatedly might be questionable if that person is coupling the PrEP use with periods of high-risk activity.

 

I think your tone was unnecessarily aggressive, though.

 

Perhaps @WmClarke 's tone was unnecessarily aggressive, but we are discussing here a topic that easily ignites feelings. You made an irresponsible statement related to HIV prevention in a forum highly populated with the AIDS epidemic survivors. I am actually surprised you were not confronted in a toughest way.

[LookingAround]

Well, after doing some research on line, you are right that I cannot find anything that would indicate that it's problematic to start PrEP and then stop it. The only argument I can find against it is that PrEP should only be taken by people who are HIV negative. If someone is recently infected but doesn't know that (and tests for HIV don't yet show the infection) and starts PrEP, he/she could be assisting their existing HIV infection to mutate to become resistant to the medications he/she is taking. So intentionally going on and off PrEP repeatedly might be questionable if that person is coupling the PrEP use with periods of high-risk activity.

 

I think your tone was unnecessarily aggressive, though.

I think his tone was fine. Uninformed and ignorant posts that sound like the person knows what they are talking about to the uninitiated can be harmful. Stop spreading ignorant misinformation.

[Rudynate]

A few days ago we were discussing the cost of Truvada. (I can't remember what thread it was or I'd post this there.) I just got my 30-day supply. I paid nothing, but Mr. Walgreen's reports, "Your insurance saved you $1924.99."

 

It wasn't my insurance, it was some kind of special program I don't know much about except that it pays. (Until June. Then I may be celibate until next January.) There probably aren't many people paying the full price. But the special programs and the other services won't cover everybody. For PrEP to be truly widespread, and for sure if it's to be adopted outside the rich countries, that price has to come down.

 

 

It is quite inexpensive in India - around $50.00/mo. A lot of guys in the UK are getting their Truvada from India because the NHS doesn't cover it. There is also a brand available from Thailand that costs about the same.

[Rudynate]

An interesting story on going the foreign generic route for PrEP. Clearly, there are still some hoops to jump through:

 

http://www.dailyxtra.com/canada/blogs-and-columns/prep-school/taking-gamble-with-generic-prep-191182

 

His problem was that he needed them right away and wasn't able to wait out the shipping time. Ordering from all day chemist is very straightforward and woks great if you've planned ahead.

[+ Gar1eth]

His problem was that he needed them right away and wasn't able to wait out the shipping time. Ordering from all day chemist is very straightforward and woks great if you've planned ahead.

 

The question about these generics are twofold. #1 Quality. #2. There's a big market world-wide market drug counterfeiting. Anyone remember years ago when a company in China sold ethylene glycol (antifreeze) as propylene glycol (a sweet syrup often added to cough medicine) and a lot of children died? Or there was a show on Dateline ( I think ) years ago on counterfeit Viagra. They looked exactly like the real thing but had no active ingredients.

 

Concerning both these problem-It's one thing to get a batch of generic Viagra that doesn't work. But what about when it's a medication you need to prevent something deadly? That's what worries me about ordering from these pharmacies.

 

Gman

[rvwnsd]

I think his tone was fine. Uninformed and ignorant posts that sound like the person knows what they are talking about to the uninitiated can be harmful. Stop spreading ignorant misinformation.

 

I agree with you 100%.

 

The question about these generics are twofold. #1 Quality. #2. There's a big market world-wide market drug counterfeiting. Anyone remember years ago when a company in China sold ethylene glycol (antifreeze) as propylene glycol (a sweet syrup often added to cough medicine) and a lot of children died? Or there was a show on Dateline ( I think ) years ago on counterfeit Viagra. They looked exactly like the real thing but had no active ingredients.

 

Concerning both these problem-It's one thing to get a batch of generic Viagra that doesn't work. But what about when it's a medication you need to prevent something deadly? That's what worries me about ordering from these pharmacies.

 

Gman

 

I also agree with you 100%.

 

For me, the risk of the medication not being effective is too great to be compensated by the lower price. That's not to say that a reputable overseas pharmaceutical company makes an inferior product. I've had prescriptions filled at Target, Safeway/VONS, and Osco/Jewel-Osco/SavOn with products that were manufactured overseas and they were fine. However, those retailers are reputable companies who acquire their inventory from other reputable companies. I don't know whether some internet pharmacy uses a reputable supplier or makes shit in some basement that looks like the real thing but isn't.While it is true that bad products have made their way into the supply chain, for me the probability that Safeway sells counterfeit Truvada is virtually zero.

[Rudynate]

I started researching Truvada as PrEP when covered by UnitedHealthcare and began treatment when coverage was switched to Anthem Blue Cross Blue Shield. UHC told me they required prior authorization because they wanted to verify that the HIV tests and liver enzyme tests were performed. Anthem does not require the prior authorization, but they will stop paying for the medication if they do not receive proof that the quarterly blood and urine tests are performed. They said they use the lab's claim as proof that the exam and tests were done.

 

Many of us remember the days when health insurance did not pay for prescriptions. There were no prior authorizations because there was no coverage. If you could afford to pay for a prescription you got it. If you couldn't you didn't. I'm not a fan of insurance companies, but I'd rather live with them than die without them.

 

That was back when most prescriptions cost $20.00 or 30.00. The total annual retail cost for prescription drugs that I take is ~$30,000.00. In addition to Truvada, I take one semi-exotic drug for a clotting disorder, but otherwise they're just average prescription drugs for typical old-guy health problems.