Re: Anthem/Blue Cross med changes

[Guest guest]

> Anthem/Blue cross recently had his Epzicom script

switched to a specialty pharmacy and " Tier 4 " status--which puts it in the

same category as really expensive chemo meds, etc. His co-pay has risen

astronomically. Oddly, they didn't do the same with his Viramune script.This is my first year with Anthem/Blue Cross and so far I've been satisfied.Prescription-wise, I'm covered by Anthem/Blue Cross (meaning embedded Medicare Part D) + California ADAP.

I have 15 prescriptions (list below in case it's helpful), 12 of which I've filled with Anthem this year, including Truvada & Viramune and have not encountered anything unusual.Mewonders if the pharmacy+Tier 4 switch is the issue.  I'd certainly revisit that decision.

Good luck to your friend.-Wes***Prescriptions covered normally by Anthem so far:

1.     

Abilify (aripiprazole) 10mg QD AM

During hard-to-get-out-of-bed period we checked my Depakote & Lamictal

levels.  04/08/2010 they were both below

normal.  Added in Abilify... “at lower

doses (2-5mg AM) it's a mood stabilizer, and it helps boost antidepressants”

for people not responding to existing antidepressant therapies.

2.     

bupropion HCL XL (generic

Wellbutrin™ XL) 450mg QD AM

a norepinephrine and dopamine reuptake inhibitor used as antidepressant, for Short Season Affective

Disorder, and for anorgasmia in response to difficulty with erections and orgasms

with Effexor XR 150mg & XR 75mg & XR 37.5.  Boosted by

concurrent Abilify 5mg QD AM; used in conjunction Pristiq™ (desvenlafaxine)

150mg QD ( & nortriptyline for neuropathy) 

with Depakote 250mg BID and Lamictal 50mg QD as mood stabilizers.

3.     

divalproex (Depakote™) (valproic

acid) 250mg tabs, 1 BID, #60, refills 11

anticonvulsant for both neuropathy &

mood swings

4.     

famciclovir

(Famvir) 500mg TID

prophylaxis for herpes outbreaks.  Shifted to famciclovir after acyclovir

shortage ~12/2009.   

6.     

gabapentin (Neurontin™) caps

300mg, 1 QD at 8:30pm, #30, refills 11

for the neuropathy in my arms and feet

7.     

lansoprazole (Prevacid™) 30mg QD,

#30, refills 11

acid-reducer (proton pump inhibitor) for

GERD (gastroesophageal reflux disease)

8.     

nortriptyline (Pamelor™) 80mg QD in evening (keep

this placed / timed away from bupropion / Wellbutrin), #30, refills 11

Nortriptyline inhibits the reuptake of serotonin, and, to a lesser extent, norepinephrine

(noradrenalin)

for neuropathy, and also depression in

conjunction with bupropion; boosted

by concurrent Abilify 5mg QD AM

9.     

propranolol

(Inderal) 40mg BID

blood pressure medicine added 1/2012 to

address shakiness / tremors11. 

ranitidine (Zantac™) 300mg QD

(dinner), #30, refills 11

acid-reducer (H2-receptor antagonist),

got rid of the burning in my stomach that started 12/91 & resumed 2/01.

Increased from 150mg BID to 300mg BID 11/06/2007 after shortness of breath

diagnosed by Hollingsworth as additional reflux.

13. 

testosterone

cypionate 200/ml 1ml/wk

for extreme fatigue, depression, erectile

dysfunction

14. 

Truvada™ (reformulated

3TC:emtricitabine 200mg and tenofovir disoproxil fumarate 300mg / VIREAD. The

former is a nucleoside reverse transcriptase inhibitor the latter nucleotide

reverse transcriptase inhibitor. Both are considered NRTIs.) QD, #30, refills

11

the 2/3 & 3/3 of my triple

combination antiretroviral therapy, along with Viramune; begun 08/25/2006 after

EpZiCom™ (Epivir-3TC

300mg/Ziagen-abacavir sulfate 600mg) 05/06/2006-08/20/2006 nearly killed me.

15. 

Viramune™ (nevirapine) 200mg, BID,

#60, refills 11

the NNRTI 3/3 of my triple combination

antiretroviral therapyNot yet refilled:12. 

Singulair™ (montelukast sodium)

10mg tablets QD, at 5-7pm, #30, refills 11

anti-inflammatory [leukotriene receptor

antagonist], using in conjunction with Advair to help reduce need for inhaled

steroids

Things I source elsewhere:5.     

fexofenadine (AllegraTM)

180mg PRN, #30, refills 11

antihistamine for allergic rhinitis &

conjunctivitis

10. 

Provigil™ (modafinil) 200mg QD AM

wakefulness agent for intense difficulty

getting out of and staying out of bed

[Guest guest]

Jeff,

An educated guess . . .

Since one of the drugs contained, Epivir / 3TC / Lamivudine, is now

available as a generic, they are incentivizing unbundling the fixed dose

combination for cost savings.

We've seen this before with combivir & Retrovir/AZT/zidovudine.

mark

Mark Hubbard

Nashville TN

Anthem/Blue Cross med changes

Posted by: " Jeff " jefftaylorps@...   rolyatffej

Wed Apr 11, 2012 7:22 pm (PDT)

Question for the group:

A friend of mine who has Anthem/Blue cross recently had his Epzicom script

switched to a specialty pharmacy and " Tier 4 " status--which puts it in the

same category as really expensive chemo meds, etc. His co-pay has risen

astronomically. Oddly, they didn't do the same with his Viramune script.

Very bizarre--has anyone had a similar experience with Anthem/Blue Cross?

If so, were you able to get this reversed? Interested to hear if others

have had the same experience. If this is not a fluke, I'm sure ViiV

(Epzicom's maker) would be interested in knowing this and could perhaps

pressure the insurance companies to stop doing this--sounds like a big

money grab to me....

Thanks in advance for sharing,

Jeff

[Guest guest]

"A friend of mine who has Anthem/Blue cross recently had his Epzicom scriptswitched to a specialty pharmacy and "Tier 4" status--which puts it in thesame category as really expensive chemo meds, etc. His co-pay has risenastronomically. Oddly, they didn't do the same with his Viramune script.Very bizarre--has anyone had a similar experience with Anthem/Blue Cross?If so, were you able to get this reversed? Interested to hear if othershave had the same experience. If this is not a fluke, I'm sure ViiV(Epzicom's maker) would be interested in knowing this and could perhapspressure the insurance companies to stop doing this--sounds like a bigmoney grab to me…."Several health plans have moved standard, first line HIV medications like Epzicom and Atripla it "Tier 4" status, as if they were experimental medications. Co-pays go to $9,000, etc.This, alas, is not a fluke.JB

[Guest guest]

"This is my first year with Anthem/Blue Cross and so far I've been satisfied.Prescription-wise, I'm covered by Anthem/Blue Cross (meaning embeddedMedicare Part D) + California ADAP."As I mentioned, this is not the first time I've heard of this. It is probably a change that the employer negotiated with their health insurance provider.I was told that Marriot Hotels negotiated this change, transferring most first line HIV therapies used in the USA to "Type IV" drugs.This will get rid of HIV positive employees by having them change jobs, if possible, or death/bankruptcy, if not.JB

[Guest guest]

On Sun, Apr 15, 2012 at 10:17 AM, J Barrowster <barrowster@...> wrote:

As I mentioned, this is not the first time I've heard of this.  It is probably a change that the employer negotiated with their health insurance provider.

I was told that Marriot Hotels negotiated this change, transferring most first line HIV therapies used in the USA to " Type IV " drugs.

This will get rid of HIV positive employees by having them change jobs, if possible, or death/bankruptcy, if not.

It's worse than that. Even under Medicare, ALL of my HIV meds are at " Tier IV " which means my co-pay is 33% until I hit the donut hole, which is almost instantly. I think this is blatantly discriminatory, and if I had the time, money, and energy I'd pursue a lawsuit. Especially with the way Gilead and others unjustifiably keep raising prices, SOMEONE needs to sue both the pharmaceutical companies and the insurance companies.

Regards,Nick -- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

It's been an ongoing battle with insurance companies and pharmaceuticals since day one of HIV/AIDS. We've gone to battle more than once. They lay low for a while, until most have either forgotten or died. Then they go back to the same ol' tactics and underhanded practices again. Since both are in it for the money, this will be the way it is until we can convince the government (ha) to do the job we employ it to do. Health care is on the top of my list for this election. I doubt that the Republicans will be of any use in that regard. They never have been.With big corporations spending the big bucks getting politicians in their back pockets, I see no end to this abuse of the sick and dying. Certainly, my believe has been, that it is one reason why no cure has been found for HIV. It would put most big pharmaceutical companies out of business if we suddenly all were healed! Until the Gay community demands change as we did before, en masse, there will be no stop to the rape of our pocketbooks. But, we have grown into a complacent and docile group of people, once again. Jon MarkleRaleigh, NCOn Apr 15, 2012, at 10:12 PM, Nick wrote:On Sun, Apr 15, 2012 at 10:17 AM, J Barrowster <barrowster@...> wrote:As I mentioned, this is not the first time I've heard of this. It is probably a change that the employer negotiated with their health insurance provider.I was told that Marriot Hotels negotiated this change, transferring most first line HIV therapies used in the USA to "Type IV" drugs.This will get rid of HIV positive employees by having them change jobs, if possible, or death/bankruptcy, if not.It's worse than that. Even under Medicare, ALL of my HIV meds are at "Tier IV" which means my co-pay is 33% until I hit the donut hole, which is almost instantly. I think this is blatantly discriminatory, and if I had the time, money, and energy I'd pursue a lawsuit. Especially with the way Gilead and others unjustifiably keep raising prices, SOMEONE needs to sue both the pharmaceutical companies and the insurance companies.Regards,Nick -- Nick , LSW6631 Clemens Ave., Apt. 1EUniversity City, MO 63130thenick58@...http://nicknicholas.net

[Guest guest]

On Mon, Apr 16, 2012 at 2:22 PM, Jon Markle <serenitylodge@...> wrote:

It's been an ongoing battle with insurance companies and pharmaceuticals since day one of HIV/AIDS.  We've gone to battle more than once.  They lay low for a while, until most have either forgotten or died.  Then they go back to the same ol' tactics and underhanded practices again.  Since both are in it for the money, this will be the way it is until we can convince the government (ha) to do the job we employ it to do.  Health care is on the top of my list for this election.  I doubt that the Republicans will be of any use in that regard.  They never have been.

With big corporations spending the big bucks getting politicians in their back pockets, I see no end to this abuse of the sick and dying.  Certainly, my believe has been, that it is one reason why no cure has been found for HIV.  It would put most big pharmaceutical companies out of business if we suddenly all were healed!  

Until the Gay community demands change as we did before, en masse, there will be no stop to the rape of our pocketbooks.  But, we have grown into a complacent and docile group of people, once again.

I think I agree with everything you write with the exception of your comment about our complacency and docility. No, we may no longer be as aggressive as we were in the early days of ACT-UP, and perhaps the time has come for a return of that period. But every day I see plenty of evidence that we are neither docile nor complacent; perhaps that is because I am in the social work profession with its commitment to social justice.

I think you're right on target with your emphasis on healthcare, and I think you're correct in your assessment that the Republicans will not be allies. The Democrats have not been entirely helpful allies, either. Too many of them also line their campaign coffers with donations from insurance and pharmaceutical companies. I am absolutely convinced that the only solution to this problem -- and the general problem of poor health outcomes in this country -- is universal healthcare, and I devote a good deal of my own policy practice towards achieving that goal.

Regards,Nick -- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

I disagree wholeheartedly with the Post saying that the Democrats have been

" less than helpful " on healthcare issues, along with the Republicans. That is

absurd. Have they not heard of ObamaCare and the years-long push for it? It's

pending decision by the politically driven conservative Supreme Court?

I won't go over all of the benefits of the legislation, but pre-existing

conditions would be eliminated as a barrier for adults in 2014, lifetime

maximums are already gone, preventative care is already available, 2.5 million

adults age 18-26 are currently covered, pre-existing condition barriers for

children are already gone, those with pre-existing conditions can now purchase

health care in govt sponsored plans, etc etc etc.

Would Republicans have done any of this? They want to repeal all of it. They

want to cut much of Medicaid, Medicare, and social security.

Are they serious?

[Guest guest]

Hi all--Below is the latest from my friend who's dilemma sparked this discussion.  Each employer's plan is different, so it's hard to generalize. And to piggyback on Jon & Nick's calls to action--every time something like this happens we should be filing grievances with the appropriate state commissions governing insurance plans, with the Better Business Bureau, and anyplace else that rates insurance plans.  The more we can make their lives difficult when they pull this stuff, and do something that affects their competitiveness in the marketplace, the less likely they'll be to do this.  

Jeff<<Hi Jeff:I called and they say it depends on one's specific plan.Viramune XR is tier 2 for me.  Ziagen and Epivir are both tier 4.  

I can only get tier 4 meds monthly and only through Curascripts, not local pharmacies. It is rigged tightly.  It could be a new $3500 donut hole just for HIV and rheumatology patients.The $100 savings card worked, thx!>>

[Guest guest]

Hi all--This from my friend at Project Inform on the topic:Back in the fall, when Anthem was negotiated plan coverage with employers they made a decision that all plan offerings to small employers (less than 125 employees) would include a new tier (Tier 4) for which the copayment would be either 20% of the cost of the drug or $150 max, with a maximum yearly copayment of $3,500 for this tier. Larger employers were given the option to keep only three tiers of coverage, but the premiums would be much higher.

At the same time, they did several other things with the HIV market, including declaring HIV drugs as a special class automatically putting them in Tier 4. The reason that Epzicom was so expensive and that nevirapine was not is that nevirapine is generic and therefore not tier 4.

Activists have met with Anthem and hope to come to some resolution of the problem. That said, , from the Fair Pricing Coalition (FPC), says this is really just the tip of the iceberg as the number of people with 4-tier plans increased by 20% last year and it's looking like that trend is continuing at the same or even higher level in the coming year. also says that the FPC is taking this issue on in the coming year with the drug companies.

As for your friend, make sure that he's signed up for the ViiV copay program. It will only cover $100 of his Epzicom co-pay, but that should at least help a bit.

[Guest guest]

Hi all--This from my friend at Project Inform on the topic:Back in the fall, when Anthem was negotiated plan coverage with employers they made a decision that all plan offerings to small employers (less than 125 employees) would include a new tier (Tier 4) for which the copayment would be either 20% of the cost of the drug or $150 max, with a maximum yearly copayment of $3,500 for this tier. Larger employers were given the option to keep only three tiers of coverage, but the premiums would be much higher.

At the same time, they did several other things with the HIV market, including declaring HIV drugs as a special class automatically putting them in Tier 4. The reason that Epzicom was so expensive and that nevirapine was not is that nevirapine is generic and therefore not tier 4.

Activists have met with Anthem and hope to come to some resolution of the problem. That said, , from the Fair Pricing Coalition (FPC), says this is really just the tip of the iceberg as the number of people with 4-tier plans increased by 20% last year and it's looking like that trend is continuing at the same or even higher level in the coming year. also says that the FPC is taking this issue on in the coming year with the drug companies.

As for your friend, make sure that he's signed up for the ViiV copay program. It will only cover $100 of his Epzicom co-pay, but that should at least help a bit.

[Guest guest]

On Wed, Apr 18, 2012 at 8:14 AM, R F <spartan.rob@...> wrote:

I disagree wholeheartedly with the Post saying that the Democrats have been " less than helpful " on healthcare issues, along with the Republicans. That is absurd. Have they not heard of ObamaCare and the years-long push for it? It's pending decision by the politically driven conservative Supreme Court?

I won't go over all of the benefits of the legislation, but pre-existing conditions would be eliminated as a barrier for adults in 2014, lifetime maximums are already gone, preventative care is already available, 2.5 million adults age 18-26 are currently covered, pre-existing condition barriers for children are already gone, those with pre-existing conditions can now purchase health care in govt sponsored plans, etc etc etc.

Would Republicans have done any of this? They want to repeal all of it. They want to cut much of Medicaid, Medicare, and social security.

Are they serious?

I'm absolutely serious. You are of course entitled to your own opinion, but if you're going to quote me, please make sure you quote me correctly. I stated that the Democrats were " not entirely helpful allies " which in truth they were not. Of course I've heard of the Affordable Care Act (also referred to as " Obamacare " by its opponents, which is why you'll never see me use the terminology), but that's not what the public wanted. More than two-thirds of the country supported a public option in healthcare reform, and the Democrats did not fight for that. The majority of the country wants a single payer healthcare system, and the Democrats are not fighting for that. Time and time again, the Democrats capitulate to the pharmaceutical and insurance interests, and the facts support this position. Even the much-vaunted Medicare prescription drug benefit is widely recognized primarily as a boon for Big Pharma.

Oh, there are some helpful provisions in the Affordable Care Act, to be sure, but the final product -- written in substantial parts BY the insurance industry -- was a pale shadow of what the public was calling for, which, IMHO, is why public opinion has now largely turned AGAINST the Affordable Care Act. I think they realize they've been snookered, yet again, by the people who supposedly represent their interests. In this instance, I think the Democrats are deservedly damned with faint praise. It was too little, too late. The Democrats are not acting in the interests of their constituents; they are acting in the interests of their major campaign donors.

Regards,Nick-- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net

[Guest guest]

On Wed, Apr 18, 2012 at 8:14 AM, R F <spartan.rob@...> wrote:

I disagree wholeheartedly with the Post saying that the Democrats have been " less than helpful " on healthcare issues, along with the Republicans. That is absurd. Have they not heard of ObamaCare and the years-long push for it? It's pending decision by the politically driven conservative Supreme Court?

I won't go over all of the benefits of the legislation, but pre-existing conditions would be eliminated as a barrier for adults in 2014, lifetime maximums are already gone, preventative care is already available, 2.5 million adults age 18-26 are currently covered, pre-existing condition barriers for children are already gone, those with pre-existing conditions can now purchase health care in govt sponsored plans, etc etc etc.

Would Republicans have done any of this? They want to repeal all of it. They want to cut much of Medicaid, Medicare, and social security.

Are they serious?

I'm absolutely serious. You are of course entitled to your own opinion, but if you're going to quote me, please make sure you quote me correctly. I stated that the Democrats were " not entirely helpful allies " which in truth they were not. Of course I've heard of the Affordable Care Act (also referred to as " Obamacare " by its opponents, which is why you'll never see me use the terminology), but that's not what the public wanted. More than two-thirds of the country supported a public option in healthcare reform, and the Democrats did not fight for that. The majority of the country wants a single payer healthcare system, and the Democrats are not fighting for that. Time and time again, the Democrats capitulate to the pharmaceutical and insurance interests, and the facts support this position. Even the much-vaunted Medicare prescription drug benefit is widely recognized primarily as a boon for Big Pharma.

Oh, there are some helpful provisions in the Affordable Care Act, to be sure, but the final product -- written in substantial parts BY the insurance industry -- was a pale shadow of what the public was calling for, which, IMHO, is why public opinion has now largely turned AGAINST the Affordable Care Act. I think they realize they've been snookered, yet again, by the people who supposedly represent their interests. In this instance, I think the Democrats are deservedly damned with faint praise. It was too little, too late. The Democrats are not acting in the interests of their constituents; they are acting in the interests of their major campaign donors.

Regards,Nick-- Nick , LSW

6631 Clemens Ave., Apt. 1EUniversity City, MO 63130

thenick58@...

http://nicknicholas.net