HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 22 of 42.
We start the 22th lesson of the PrEParing MOOC on the topic “Paying for PrEP: Patient Assistance Programs”. The lecture was read by Jess LaRicci, PrEP coordinator at Johns Hopkins School of Nursing Reach Initiative.
The information given in this lecture will be useful to both healthcare providers and patients. We will resolve the options for paying PrEP, explain the costs of insurance coverage of PrEP and understand the patient assistance programs.
Often doctors in clinics, consultants in pharmacies are lack of understanding of PrEP. In the US and other developed countries, programs of insurance companies covering the cost of PrEP help people take the first step in their protection against HIV. The procedure of obtaining such insurance will require some effort and time.
This program is used only for private insurances, and it helps with the co-pays or any of the pharmacy deductibles. Plus the program does not limit the amount of income of the insured person. A person receives reimbursement up to $3,600 within twelve months and can reapply yearly for this program. Figure 1 shows an example of an application for such a program.
The procedure is quite simple, just download the questionnaire, fill out and send off. In a case of confirmation, you will receive a co-pay card. Next, you will need to activate this card on the project’s website. Also, don’t forget to get a prescription from your medical provider.
In some cases, you do not even need to get a physical card, just call, get the personal card number and activate it online. Most pharmacies selling the drug Truvada, accept Gilead co-payment cards.
For patients insured by Kaiser, it’s a little different as the fact that you have to pay for the medication up front.
The program for the insured in the Kaiser Fund is somewhat different, in which the patient must first pay the tablets for PrEP in full, then fill out a form for the return of costs, it can be found on the program website. You will need to attach a prescription and a label from the packing of tablets.
There are also programs are based on the poverty guidelines. The recommendations for 2017 (Figure 2) show the level of income in the household, which allows this household to be classified as a poor. What is great about these programs is if someone does not have a computer, a medical provider can always call them, and it’s just as helpful as based on income - you have to be less than 400% of the Federal Poverty Guideline.
Apparently, the procedure for reimbursement of expenses for the PrEP for the poor is bureaucratized. Probably, the organizers of insurance are afraid of abuse and resale of tablets in the gray market.
There is another Patient Advocate Foundation Co-Pay Relief program. As of June 2016, the maximum amount of coverage of medical expenses for PrEP was $3,000. The recipient of insurance always can reapply and get another $4,500 coverage. You can also send repeated applications for the next year. Moreover, it can be sent not only by the patient but also by a medical provider on behalf of the patient. It is noteworthy that this program can be used together with the Gilead co-payment card, as well as with the insurance program for individuals from the Patient Access to Treatment Network (PAN) Foundation.
PAN insurance covers all costs of purchase of medicines with the same limit of $7,500, but participation in it is limited to the size of a person’s income, it must not exceed by more than five times the poverty threshold for a household. Plus of the PAN insurance - the patient should not be a US citizen.
The US national drug reimbursement program is different from the Gilead co-payment card; it offers reimbursement for uninsured people. The procedure for obtaining it is a little more bureaucratized than getting a card - for a decision on payment, it will take two or three weeks after sending the prescription to the tablets. If confirmation is received, the refund of fees shall be granted immediately for six months.
Gilead made a special support site, start.truvada.com, where you can get detailed information, US residents can find a counselor on PrEP and even more - get female or male condoms, a free test for HIV and hepatitis B and if positive - perform a test for the genotype of the virus.
The email help project “My experience of PrEP at [email protected]” was initiated by the Chicago AIDS Foundation. The staff of the fund does not assist in reimbursing the costs of the PrEP, but they can ask the question about PrEP in English. Also, the project helps people collect the necessary documents for an application for a refund.
For today, the review is completed, if the information you read in the article seems to be important — please, share it on a social network or send it to friends by email or via Whatsapp, Viber, Telegram or another messenger.
Tomorrow we are waiting for the 23th day. If you have not already signed up for the PrEParing course on the Coursera platform, it’s never too late to do it, just follow the link https://www.coursera.org/learn/prep.
Stay with us and stay healthy!
