Sunday, October 24, 2010

Merck: "Need HIV Meds? Have Private Insurance? And Large Co-Pays? Okay, We'll Help!"

I will dutifully applaud Merck's Friday announcement of a new rebate program for people living with HIV -- who happen to have private insurance, and have substantial out-of-pocket co-pays on Isentress.

However, there are many, many people living with HIV, who do not have insurance, and are not eligible for Medicare and/or Medicaid, because they have income of more than 150 percent of the federal poverty level (about $18,000). For these people, Isentress® now costs about $12,900 per year -- all out of pocket (which is often prescribed in combination with a cocktail of other drugs -- so that the annual bill for US patients runs close to $22,000). You do the math, here -- after just the Isentress (not any of the other meds!), all food, rent, clothing, ultilities -- all other expenses must be less than $5,000 per year. It is not possible. And it is ugly. It generally means that these people stop taking their meds for over two-thirds of each year -- as soon as the subsidies run out. In the longer term, this costs us all more -- not less -- as each of these people get sicker, sooner, and need more expensive emergency care. This is -- at present -- an illogical and inhumane non-system.

In any event, per the WebWire online news site, then:

. . . .People who have been prescribed Isentress® who meet certain requirements are eligible to participate in the program, in which they can receive a Savings Coupon for up to $400 toward out-of-pocket costs on each of up to 12 eligible prescriptions of Isentress, regardless of the number of tablets supplied on the prescription. The program applies to eligible patients who have private health insurance with a co-payment for the prescription. Savings are limited to co-pay amount and eligibility restrictions, terms and conditions apply. . . .

The program is not available to patients who are covered under Medicaid, Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered). . . .

So -- nice, if you're a US citizen living with HIV -- and you're fully insured, by a private insurance company -- and you are paying over $3,000 in annual out-of-pocket co-pays.

If you aren't, and you aren't eligible for Medicare/Medicaid. . . this is truly of no help. Still, I applaud it.

1 comment:

Anonymous said...

Is it any wonder that countries such as India, Thailand, Brazil, and others have demanded the right to manufacture branded drugs generically so their citizens with HIV can afford them?

Would that drug companies in the US would treat low-income with little or no insurance people who need expensive drugs in a more humane manner.