The Overwhelming Expense

There has always been a discussion around how much more expensive healthcare costs is in the United States. Unfortunately, many individuals do not take notice of this matter until they are faced with the costs themselves.

When considering the costs associated with managing HIV treatment, the expense is overwhelming for both society and individuals.

Estimates of HIV medical costs

According to the academic journal, Medical Care, the medical cost estimates for persons living with HIV ranged from $1854 to $4545 a month in 2015.¹ Since the cost of living increases every year, it is likely this cost has also increased over the last several years.

The “lifetime cost for persons who become HIV infected at age 35 is $326,500:¹

• 60 percent for antiretroviral medications
• 15 percent for other medications
• 25 percent for non-drug costs

The lifetime estimated cost is affected by individuals who are infected prior to age 35, individuals who are diagnosed with a CD4 count of 200 or less, and any opportunistic infections that are contracted.¹

The cost of my antiretroviral Biktarvy

The antiretroviral that I currently use is Biktarvy. The cost of one bottle of Biktarvy is $3,419.21. With my Medicare Advantage plan, I have a prescription deductible of $395 and for Tier 5 specialty tier drugs, I have to pay 25 percent of the co-pay.

This resulted in the first payment for my prescription of Biktarvy being $1,249.80! Until I meet the prescription catastrophic coverage, my co-pay for this one prescription is $854.80. After I make it into the prescription catastrophic coverage section, my co-pay becomes $170.96. This high cost of a prescription co-pay for one type of prescription is breathtaking and heartbreaking for so many individuals.

Reviewing end-of-year healthcare costs

This time of the year, there are various documents sent out for individuals to use in order to complete their taxes. Among the documents that I received was one from the insurance provider that I had from May through the end of the year.

My total healthcare expenses were slightly above $90,000 (again, this does not include the first four months of the year). For these months, the out-of-pocket healthcare expense for me was about $6,000. Without some assistance, this would cost me around $750 a month. While living on disability, this would be impossible for me.

Surviving with the help of assistance programs

The only way I managed to survive being on Social Security Disability and these expenses were through assistance programs. My specialty pharmacy was able to help me apply for prescription grants that would go towards my Biktarvy prescription.

In addition to that, the state of Texas has an AIDS Drug Assistance Program (ADAP) called Texas Medicaid & Healthcare Partnership (THMP). This program covered the out-of-pocket expenses of other prescription drugs. The abortive medication for my migraines, Sumatriptan injections, costs over $100.

Sadly, medical costs like this can lead to so many individuals not being able to take their medications. This is even more likely when individuals do not know about the existence of assistance programs or how to apply for them.

How do you balance your medical expenses?