insurance for hiv meds in USA, NYC.
hello all 😀
I have a question about the insurances and hiv medications in NYC. I am recently hired as a NYC city employee and my employer offers a number of insurances to choose. I was wondering if any of you is familiar with Emblem Health's GHI CBP plan for hiv meds? Or my other option is HIP HMO. I would really appreciate any kind of help about choosing one of these two. Some of they say there is 40% coinsurance which results in ridiculous amounts for my hiv med, (biktarvy)
Anyone out there in NYC and familiar with insurance for city employees?
Hi @ssnyc , I'm glad you posted. Insurance can be tricky. I know some insurance websites have 'cost calculators', is that how you determined the cost for Biktarvy?
This may be information you already have, but a few resources and info on cost of care for those living with HIV - https://h-i-v.net/access-cost
Let us know how it is going, and I hope someone is able to chime in with some personal experience - Liz (Team Member)
@sssnyc
I am not familiar particularly with your plan. However, I would call the insurance company directly and speak with the pharmacy. The pharmacy department should be able to tell you if your specific medication is covered under each plan. I personally, have had an insurance company with a decent plan but it did not cover name brand specialty medication. As you can imagine, as a fellow Biktarvy user, that was not happening. The insurance department can see plan specifics by looking up your employer group, and the plan booklet . . even before you enroll. Also, I have used the Biktarvy copay assistance program before (https://www.gileadadvancingaccess.com/financial-support/gilead-copay-card). Its worth looking into.
Good luck, and let me know how it goes.
-Ze (H-I-V.net Team Member)unfortunately, the insurance companies do not answer any questions before being enrolled to them. And the pharmacist said she will not be able to tell until she makes the claim for the sold medication. 🙁 I’m sorry you are getting push back. From a former health insurance rep, they have access and should be able to service you. However, I went to your plan page: https://www.emblemhealth.com/resources/city-of-new-york-employees/ghi-cbp
If you scroll to the bottom under Drugs Covered, it shows two plan booklets. I did not see Biktaryvi specifically in the base plan but the full RX plan does show Biktaryvi as a covered anti-viral medication.
I do not specifically know without looking at your plan book, etc but this is the best relative information I could find. This plan seems to be more specific on what pharmacy plan you elect for coverage of the medications.
I hope this helps.
-Ze (H-I-V.net Team Member)
While I cannot answer your insurance question, I can provide some assistance information.
This website is for assistance programs offered by the company that sells Biktarvy
https://www.biktarvyhcp.com/support/cost-assistance
Additionally, there should be HIV assistance organizations in your community. You can try searching for a community case manager for HIV. They can help you figure out options for your care.
Another website that might be helpful
https://www.rxresource.org/prescription-assistance/new-york-aids-drug-assistance-program.html
I hope this helps some. - Heather R (team member)
Perhaps can help. Khafre (H-I-V.net Team Member)
