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Can I Use My Copay Card for Descovy?

Yes. Now that Descovy is an approved pre-exposure prophylactic (PrEP) by the Food and Drug Administration, you can use your Gilead Advancing Access copay coupon card to pay for your prescription of Descovy. If you don’t already have a card, you will need to meet eligibility requirements to join the program and access its benefits. Contact our team at Nurx today for help enrolling for the Gilead Advancing Access program.

The Advancing Access copay discount card is good for those insured by commercial policies but not for those enrolled in state or federal prescription drug programs. Medicare Part D and Medicaid are the federal programs excluded from eligibility for the Advancing Access copay card.

The Cost of PrEP

PrEP is an expensive name-brand drug with no current generic equivalent. The retail cost of PrEP begins at $2,000 for a 30-day supply. Discount coupons and cards can reduce your out of pocket costs by covering your copay or reducing the monthly cost of Descovy. The Gilead Advancing Access copay program may save Descovy users out-of-pocket costs of up to $7,200 per year. These savings apply to the medication only and do not include clinical visits or lab tests.

Know Your Insurance Plan

It’s important to know what your commercial insurance covers and what it doesn’t. In some cases, Descovy may be considered specialty medication and have specific requirements or eligibility to cover the cost of your medication. Deductibles may have to be met before copays start or copays might occur right away. Get the details from your insurance provider so that you understand how and when you’re covered and whether or not you qualify for assistance. Consult with a team member here at Nurx™ if you need assistance paying for your medication. We can help reduce your costs to $0 in many cases.

Understanding Deductibles and Copays

Discount coupons and copay cards help people afford their medication. Recently, some health plans have decided to no longer count the use of copay cards toward deductibles and out of pocket maximums. Typically, a copay card decreases out of pocket costs for medication while applying the original retail cost toward an individual’s deductible.

The increased use of discount copay cards has prompted some insurance companies to adjust policies in order to get some of their cost back. When insurance companies apply an accumulator adjustment the full cost of your medication may not be applied to your deductible.

For example:

  • The retail cost of Descovy is $1,800
  • Your discount copay card brings the cost down to $50 and the remainder is paid by Descovy’s manufacturer.
  • Under traditional policies, the full cost of $1,800 would be applied towards your deductible even though you only paid $50.
  • Under the accumulator adjustment policy, only the $50 you paid out-of-pocket is applied to your deductible, not the full cost of the medication.

Be informed about how your insurance company counts your copay towards your medication and shop for policies that do not apply an accumulator adjustment.

Commercial Versus Federal Insurance

Commercial insurance is defined as any private insurance company that provides your health care policy. Commercial insurance plans may come with varying deductibles and copays, which represent what you’ll pay (deductible) before full coverage starts and what you’ll pay out of pocket (copay). Some plans require your deductible be met before incurring copays, while other plans incorporate copays right away. These may also vary, depending on your plan.

Federal Insurance includes Medicaid and Medicare Part D. These plans are generally not part of Gilead’s Advancing Access program because they may include reimbursement of prescription cost. For Medicare recipients, once your deductible has been satisfied, your copay for Descovy may range from $42 to $1,800. In the Medicare donut hole stage, also referred to as the coverage gap, you’ll pay more out-of-pocket for prescription medication.

The term “donut hole” describes a temporary limit on the coverage of prescription medication. For 2019, Medicare Part D recipients who’ve paid $3,820 on prescriptions enter the donut hole stage. That figure climbs to $4,020 in 2020. Once you reach this stage, you pay no more than 25% of the retail cost for many brand-name prescriptions. Some Medicare plans include coverage while in the donut hole, so be sure you understand what is covered and what is not.

For example, consider how these figures would apply in a coverage gap:

  • The retail cost of Descovy is $1,800.
  • A $5 dispensing fee is added, but Medicare Part D would cover 75% of that dispensing fee.
  • You’d pay 25% of Descovy’s retail cost out-of-pocket while in the coverage gap. Medicare Part D would pay just 5%, but the manufacturer would offer this medication at a 70% discount. $1,805 X 0.25 = $451.25.

Although you’ll only pay 25% of Descovy’s cost, 95% of the medication’s total cost counts toward out-of-pocket expenses. This reduces the amount of time you’re in the donut hole. For medications like Descovy, inquiring if your Medicare plan offers additional coverage while in the donut hole can save you time and money.

How We Can Help

Discount coupons and copay cards can help reduce your overall costs and lower out of pocket expenses. Here at Nurx, we strive to help you apply for assistance to get your medication at an affordable price or even at no cost to you.

Our care team provides the complete process to get you started with Descovy:

  • Get an at-home PrEP Test Kit
  • Discuss your medication options
  • Understand and apply for payment assistance
  • Get your medication delivered
  • Get tested regularly

HIV and PrEP by the Numbers

As education and knowledge about HIV and PrEP continue to expand, new and faster diagnoses mean those with HIV are receiving treatment sooner. The use of PrEP has grown as well. The CDC reports that between 2012 and 2016, PrEP use grew by an average of 73% per year.

  • At the end of 2015, 1.2 million people in the United States were living with HIV
  • By the end of 2016, 77,120 people were prescribed PrEP
  • In 2017, there were 38,700 new HIV diagnoses in the US
  • By the end of 2018, 37.9 million people were living with HIV globally
  • There are over 174,000  worldwide facilities providing HIV testing and counseling
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