![]() Genvoya: Covers the first $7,200 per year of co-payments. Norvir: Covers up to $1,200 a year for co-payments.Įvotaz, Reyataz, and Sustiva: Up to $7,500 annually for co-payments, deductibles, and co-insurance in all commercially-insured plans.Ītripla, Biktarvy, Complera, Descovy, Emtriva, Genvoya, Odefsey, Stribild, Truvada, and Tybost Kaletra: Co-payment assistance covers the first $400 per prescription per month. Adapted from HIV Pharmaceutical Company HIV Patient Assistance Programs and Cost-Sharing Assistance Programs: bit.ly/1XIahvN Special thanks to NASTAD’s Britten Pund and Amanda Bowes for much of the information listed here and to Tim Horn for his review. This “one stop shop” portal provides a streamlined, online process to qualify individuals and deliver the donated medications of the participating pharmaceutical companies through a mail-order pharmacy. HarborPath creates a single place for application and medication fulfillment. HarborPath operates as a streamlined, online portal for PAP access. Once the form is completed, case managers or individuals then submit the single form to each individual company, reducing the overall amount of paperwork necessary to apply for a patient assistance program. This form combines common information collected on each individual companies form to allow individuals to fill out one form. IN 2012, the Department of Health and Human Services (DHHS), along with seven pharmaceutical companies, the National Alliance of State and Territorial AIDS Directors (NASTAD), and community stakeholders developed a common patient assistance program application form that can be used by both providers and patients. An individual is eligible for the HarborPath ADAP waiting list program only if he or she has been deemed eligible for ADAP in his or her state and is verified to be on an ADAP waiting list in that state. HarborPath, a non-profit organization that helps uninsured individuals living with HIV gain access to brand-name prescription medicines at no cost, operates a special patient assistance program for individuals on ADAP waiting lists. Each individual company has different eligibility criteria for application and enrollment in their patient assistance program. The bad news is that changes may be on the way for consumers, as some big health insurers no longer allow the amount of the co-pay cards to be applied towards their deductible or out-of-pocket maximum, or steer them towards other cost-containing measures such as step therapy or individual generics that break up an STR.Ī cost-sharing assistance program (CAP) is a program operated by pharmaceutical companies to offer cost-sharing assistance (including deductibles, co-payments and co-insurance) to people with private health insurance to obtain HIV drugs at the pharmacy.Ī patient assistance program (PAP) is a program run through pharmaceutical companies to provide free or low-cost medications to people with low-incomes who do not qualify for any other insurance or assistance programs, such as Medicaid, Medicare, or AIDS Drug Assistance Programs (ADAPs). ADAPs, several non-profit organizations, and the pharmaceutical companies have assistance programs in place to help you pay for the treatment you need. While in the past these increases usually haven’t directly affected someone who has drug coverage through their health insurance plan, increasingly individuals have to pay co-insurance (a percentage of the cost of the medication). The prices of HIV drugs continue to rise every year at an average of 7–9 percent. Today’s therapies are vastly improved over the first drugs used to treat HIV, but these advancements come at a cost.
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