Affording Medicare Prescription Copays

Facing the high costs associated with acquiring the HIV antiviral medications can be incredibly stressful. Sometimes even with insurance, the out-of-pocket expense left for the patient to deal with can be astronomical and unmanageable for a lot of individuals. Luckily today, there is assistance available and very helpful people.

Assistance with the help of a specialty pharmacy

Being connected with the right specialty pharmacy can make a drastic difference in the experience of acquiring HIV antiviral prescriptions.

I was worried about copay cost

My first Infectious Disease (ID) doctor was the person who told me about the specialty pharmacy that I still use today. I originally had commercial insurance, but I was still worried about the copay cost.

When they called me back after verifying my insurance, they asked me additional questions to apply for a copay card. The pharmacy managed the headache for me. Their efforts to acquire a copay card resulted in my medication having no out-of-pocket cost.

Working through Medicare nuances

When I needed to get my prescriptions on Medicare, I was extremely worried about the cost. I felt like I could not breathe when the pharmacy informed me that the Medicare copay was over a thousand dollars. The manufacture discount cards also only work with commercial insurance, not Medicare.

But again, the specialty pharmacy stepped up in a way they did not have to in order to help me. The pharmacy employees worked hard to apply for different programs to cover my copay until they got the grants approved for me. They took a big portion of the stress off me by finding and apply to the grants for me.

Maintaining uninterrupted HIV treatment

For part of the application for the grants, the pharmacy had to get documents from my ID doctor. Of course, my doctor filled out her part. The office also reached out to me to have me come by the office and sign a form as well.

An attentive doctor

My doctor realized that the process of getting my medication paid for would result in me running out of my daily medication. When I stopped by her office to sign the paper, there was an envelope with a bottle of my medication. My doctor was able to make sure that my treatment was not interrupted during this process, which is an extremely good thing.

The THMP State Pharmacy Assistance Program

I applied for the Medicare low-income subsidy program but did not qualify because I made a tiny bit too much a year. Due to this denial, I was able to apply for the HIV State Pharmaceutical Assistance Program (SPAP), which is run by the Texas HIV Medication Program. This program works with the Medicare Part D prescription plans.

Texas is not the only state that has SPAP. A major benefit to this program is that it covers all prescriptions copays from Medicare Part D. The amount of help that this program has provided me

Managing Medicare copay costs

Getting help to pay for your high prescription copays while on Medicare may seem scary. Despite this, there are ways to manage these costs. I hope some of my experiences can assist others in finding ways to manage their own costs.