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Taking PrEP? Thinking about it? Find an Illinois health plan that works for you – and get help paying for it!

November 13, 2017

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People who are HIV-negative and vulnerable to HIV infection can take a daily medication called Truvada to help prevent HIV. It’s recommended by the U.S. Centers for Disease Control and Prevention and the Chicago and Illinois Departments of Public Health.

If you need health insurance, you can shop for and choose a plan on the health insurance marketplace (must be before Friday, Dec. 15). If you take PrEP, or are considering taking PrEP, we want to share some great resources to help you find the best health insurance plan for you and get help paying for PrEP.

 

Pick a PrEP-Friendly Plan

Start here: Go to PrEPcost.org to find plans offered in your area, see if you can get help paying for the plan (known as a “subsidy”), and learn how much Truvada might cost. Developed by our partner the National Alliance of State and Territorial AIDS Directors, PrEPcost.org is a new tool to make it easy to find the right plan for you. It will also tell you if a plan has any kind of restriction that might make it harder to get PrEP, such as a requirement for a “prior authorization (your provider has to get approval from your insurance company before they can prescribe PrEP).” Prior authorizations require more time and paperwork, so it’s good to try and avoid them if possible.

Step 2: Choosing a plan can definitely be complicated. If you need help, please make an appointment with a trained assister. Tip: Schedule your appointment ASAP — don’t wait until the last minute! This open enrollment season is really busy! Remember it ends Dec. 15th.

Step 3: Enroll! Once you’ve found the plan that’s right for you, visit Healthcare.gov or the Illinois Health Insurance Marketplace (or call 866-311-1119) to enroll in a plan. The deadline is Friday, Dec. 15. You can link directly to these sites via PrEPcost.org as well.

 

Get help paying for PrEP

Check out (and sign up for) these two programs that can help you pay for Truvada.

1)PrEP4Illinois: Start by enrolling in the PrEP4Illinois program (visit www.PrEP4Illinois.com or call 800-825-3518). It’s run by the Illinois Department of Public Health (IDPH). It works with the Gilead co-pay assistance program (see below), and you may be able to get Truvada with no out-of-pocket costs (for free!). PrEP4Illinois will help you access PrEP if you are insured or uninsured through a simple application process that connects you to a variety of resources. The program will help cover people who are under 18, or who are insured but might not want to use their insurance (if they’re worried about using parental insurance or are in situations where there may be intimate partner violence, for example). You must be an Illinois resident to use this program.

2)Gilead Co-Pay Assistance Program: Gilead (the manufacturer of Truvada) has a copay assistance card that will help reduce your out-of-pocket costs for Truvada. If you have insurance, you can apply for a card at https://www.gileadadvancingaccess.com/. There are no income limits. The card will pay up to $3,600 per year toward the cost of your prescription and can help you meet any deductible required by your plan. Note that not all insurance plans will allow you to use a copay card, or may have special conditions. For example, BlueCross BlueShield plans allow co-pay cards, but they do not count towards meeting your deductible. Check with the insurance plan before enrolling. Tip: PrEP4Illinois will help you enroll in the Gilead Co-Pay Assistance Program, so start there first.

More information on Gilead’s patient assistance programs:

  • Gilead operates an integrated website that can help you navigate your insurance and obtain financial support
  • Uninsured? Gilead also has a Medication Assistance Program that will cover the costs of Truvada as PrEP if you are eligible. Check the website for eligibility and other program information.
  • If you need more help paying for PrEP, the Patient Access Network Foundation and the Patient Advocate Foundation may provide support to people with insurance. The Gilead copay card may be used with these programs. Assistance from these two foundations may start and stop during the year, so make sure to check each foundation’s website to see if they are active.

 

Find a PrEP Provider

Finally, to learn more about PrEP and where to get it, call the Chicago PrEP Line at 872-215-1905 or visit www.PrEP4Love.com. The operators at the Chicago PrEP Line are also able to help you with insurance questions in addition to answering your PrEP questions and giving referrals to friendly PrEP providers.

 

More Tips 

  • Denied? Speak up! Insurance companies almost always cover Truvada as PrEP. However, if for some reason you are denied, you can always appeal the decision. Our experience shows that folks who appeal are often successful. “The squeaky wheel gets the grease,” after all, so when it comes to your health care and your well-being, it’s good to squeak as loudly and persistently as necessary.
  • Verify. Insurance companies can change their formulary (list of drugs they cover) and coverage at any time. Always verify medication coverage and costs directly with a plan before enrolling.
  • Prior authorization. Plans that require prior authorization for Truvada will make your health care provider fill out forms for you to receive PrEP. This could cause delays, but many providers and pharmacies will help you with this – they have a lot of experience with these sorts of things. If you must choose a plan that requires prior authorization, do so with your eyes fully open. Note that plans can add or remove prior authorization requirements at any time.
  • Consider the total cost of PrEP (including medical visits and labs). When choosing a plan, consider how much it will cost to visit your health care provider four times a year as recommended by medical guidelines for people who take PrEP. PrEP requires ongoing HIV and STI testing – these services can potentially be utilized at public health departments and community organizations, so you don’t necessarily need to do them in your doctor’s office (which can be expensive and not always fully covered by insurance plans.) Also consider the costs of lab visits that are required for PrEP. PrEPcost.org will show you these costs. Make sure your provider of choice is in the health plan’s network to save the most money.
  • Choose your plan wisely. People who earn less than $30,150 (250% of Federal Poverty Level, for a single person) will have lower deductibles and out-of-pocket costs if (and only if) they choose a silver plan purchased from www.healthcare.gov. If you can afford it, choose a silver or gold plan — you will get much better coverage for a slightly higher premium. Catastrophic plans with very high deductibles and bronze plans will likely be more expensive for people who take PrEP and are usually not good value. However, everyone is different. Talk to a health insurance navigator if you have questions. 

Categorized under Chicago, Health insurance, Illinois and Prevention.

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