The brand name of a drug that is used to treat and prevent HIV is Truvada. Antiretroviral drugs are the name for these kinds of drugs. But does Medicare cover Truvada?
To qualify for Medicare coverage of Truvada, individuals must have prescription medication coverage.
Medicare Part D provides prescription medication coverage for original Medicare recipients.
Prescription drug coverage is a standard feature of Medicare Advantage plans.
But Truvada is usually neither free nor cheap. This article will tell you how Medicare covers Truvada and what you can do to save money.
What is Truvada?
To combat HIV infection, doctors prescribe Truvada, a name-brand drug. It is also used to protect those at high risk of contracting HIV from contracting the virus. Pre-exposure prophylaxis refers to HIV prevention before any potential exposure (PrEP).
Emtricitabine and tenofovirdisoproxil fumarate are the two active ingredients of Truvada. The two pharmaceuticals share the category of nucleoside reverse transcriptase inhibitors (NRTIs). These medications can be quite helpful in the case of a viral infection. To combat HIV, these particular antiviral medications are used (human immunodeficiency virus).
Truvada is a tablet that must be taken orally once per day.
How does it help with HIV?
HIV cannot be cured with Truvada. Instead, it gradually reduces the amount of infection in your system. This is achieved by inhibiting a viral enzyme necessary for replication. Since Truvada prevents the virus from replicating, it can significantly reduce the amount of HIV in your body.
Tests can no longer identify HIV after the virus load in the blood falls below a particular threshold (200 units per mL). The infection is said to be under control as soon as that happens.
Once the virus is undetectable, studies demonstrate no danger of sexually transmitted disease.
How does it stop HIV from spreading?
Non-HIV-positive people can lessen their chances of contracting the virus through sexual contact or injection drug usage by taking Truvada. Taking Truvada before exposure to HIV is called pre-exposure prophylaxis (PrEP).
Daily usage of the medicine reduces the risk of HIV transmission through intercourse by 99 percent and injectable drug use by 74% in HIV-negative adults.
To effectively combat HIV, Truvada must maintain steady blood levels throughout the body.
However, the CDC still advises using a barrier technique, such as a condom, during sex. Even though Truvada greatly decreases the amount of HIV in the body, transmission can still occur without one. Besides preventing HIV, this also shields you from chlamydia, gonorrhea, and other STDs.
Only the brand-name version of Truvada is presently on the market. There is no generic version of it out there right now.
Emtricitabine and tenofovirdisoproxil fumarate are the two active pharmaceutical components in Truvada.
Side effects of Truvada
Truvada can cause minor or serious side effects. Some of the most common adverse reactions of Truvada are detailed below. This list doesn’t include all possible side effects.
Consult your pharmacist or doctor if you have any queries about the potential side effects of Truvadarx or for advice on managing a bothersome side effect.
Most prevalent side effects
Side effects of Truvada include:
Nausea, bone pain, dizziness, high cholesterol, respiratory illnesses, insomnia (trouble sleeping), fatigue, sinus infection, vomiting, headache, diarrhea, sore throat, rash, etc.
Some people report that these adverse effects disappear within a week or two. Consult a physician or pharmacist if the symptoms worsen or persist.
Serious side effects
- Problems with the liver. Symptoms of liver problems include swelling in your abdomen (belly)or pain. Moreover, the symptoms include stomach pain, vomiting, exhaustion, and yellowing of the skin and eyes.
- Depression. Feelings of sadness or lowness, lack of interest in formerly enjoyable activities, insomnia or excessive sleep, and a general lack of vitality are all possible symptoms.
- Loss of bones, immune reconstitution syndrome, kidney problems, lactic acidosis, worsening of hepatitis B virus infection, and so on.
Does Medicare cover Truvada?
Medicare Part D plans and prescription medication insurance cover antiretrovirals like Truvada.
However, because private insurance firms provide Part D plans, there is some variation in how much each plan costs and what it covers.
A 2022 study looked at how much of the cost Truvada Medicare patients usually paid. According to the study results, Medicare covered anything from 50% to 76% of the total cost of the medicine.
- Whether or whether you have reached your annual prescription drug deductible is one of the many variables that will affect how much you will have to pay.
- How high of a tier is Truvada in your plan’s tiering scheme? What your cost-sharing requirements are
- To what extent can you receive financial aid from the government or other sources
Truvada is classified as a category 5 (specialty) drug by many health insurance providers. Drugs in Tier 5 are the most expensive compared to Tier 1-4.
Check your formulary to see if and how Truvada is covered under your plan. Here is a rundown of the pharmaceuticals your insurance will pay for.
Use Medicare’s plan comparison tool to ensure your new Medicare Part D plan covers your medications.
What parts provide coverage?
Every Medicare beneficiary must have prescription medication coverage. This means that one must have prescription drug coverage that is at least as comprehensive as the most fundamental Medicare PDP.
Two routes can be taken to get a PDP. The first option is to enroll in a private insurance company’s Medicare Part D coverage.
The second alternative is to enroll in a Medicare Advantage program (commonly known as Medicare Part C) that provides coverage for your medications.
There are two ways to get Medicare to cover your Truvada and other meds.
What about coverage for Medicare Part C?
Private insurance businesses also supply Medicare Part C (Medicare Advantage) policies. They offer the same coverage as traditional Medicare (Parts A and B) and often add extras like eye and dental care.
Medicare Advantage plans may or may not include prescription medication coverage. You can switch to a different plan that covers prescription drugs if the one you initially selected does not. You can make this adjustment during one of the open enrollment periods spread throughout the year.
Treatment with Truvada for HIV may make you eligible for a
. They are a special Medicare Advantage plan for those with several chronic illnesses, such as diabetes, heart disease, or HIV.
Looking up Truvada on your Medicare Advantage plan’s formulary is the first step in determining how much it will cost you each month. You may find out what prescription restrictions and criteria apply to your Truvada prescription by consulting the formulary, which will also inform you what tier Truvada is in.
As the price of the drug may alter once you’ve reached your deductible, it’s important to know what that is for your particular plan.
Does Insurance Cover Truvada?
When prescribed by a medical professional, PrEP is usually covered by health insurance. Your responsibility is to contact your insurance carrier and inquire whether or not the prescription is covered and, if so, what your co-pay will be. Your co-pay may be more for this drug than for generics you take regularly. Even if your insurance doesn’t pay for PrEP, you don’t have health insurance, or your co-pay is too costly, you may be able to purchase your medication.
The company Gilead, which produces the PrEP medications Truvada and Descovy, provides co-pay assistance programs to ensure that people who need it can afford to take the medication. Other services and programs may also be available to you, and they may help you better comprehend your health insurance plan and provide financial aid to reduce the high cost of your prescriptions. Online PrEP ordering from Nurx is a convenient and cost-effective way to ensure you always have access to this lifesaving drug.
Unless there is a compelling medical need to use Truvada, generic PrEP is what Nurx will recommend.
What is the cost of Truvada?
The American Journal of Public Health reports that the average monthly cash price of Truvada is $2,000.
The cost of Truvada may be affected by many variables.
- what kind of drug plan does someone has
- private insurance company in charge of running the plan
- if Medicaid also covers a person
- If someone gets Supplemental Security Income (SSI)
According to the American Journal of Public Health, the average yearly cost of PrEP drugs (including Truvada) for someone with a stand-alone PDP is between $2,276 and $2,430.
Medicare Advantage plans that cover prescription drugs typically cost between $1,354 and $2,277 per year for each enrollee.
Preferred generics are the least expensive category of pharmaceuticals covered by prescription drug plans, while brand-name and specialty medications fall into the highest-price category.
As a brand name, Truvada is currently classified as a very expensive medication.
Many out-of-pocket expenses come up when someone has Medicare Part D coverage and needs to buy drugs.
Some of these costs are:
- A monthly premium is a monetary commitment that can vary widely based on many criteria, such as the type of plan selected and the amount of supplementary assistance that can be received.
- In 2022, the deductible for any Medicare Part D plan could not be more than $445.
- After clearing their deductible, some patients may be required to pay a copayment or coinsurance for their prescription drugs.
According to an unbiased prescription medicine pricing comparison website, the following is the average cost of a 30-tablet (30-day) supply of Truvada:
A deductible copayment between $54 and $68 is required before the deductible is reached. The typical copayment ranges from $13 to $68 and is required once the deductible has been reached.
The averages are included here for clarity. The cost of Truvada varies widely from person to person.
Truvada vs. generic medication
Generic drug safety is a top priority for the FDA. Hence the agency strictly controls the manufacturing and distribution of these drugs.
All generic drug versions must be equivalent to the corresponding brand-name version in terms of dose, quality, and administration method.
A person should consult their physician if they experience unusual side effects when using generic Truvada.
Assist with costs
Various resources exist to help cover the expense of antiretrovirals like Truvada. All of the following are included in this category:
- ADAPs, or AIDS Drug Aid Programs, are state-run initiatives providing financial assistance to low-income people needing HIV/AIDS medication. Help with premiums, deductibles, co-pays, and co-insurance are all examples.
- Medicare’s Extra Help program helps low-income people with few alternative options pay for prescription medicines. With extra help, Truvada may cost $9.20 in 2021.
- Medicaid is a federal-state program that helps low-income people pay for medical services and prescriptions.
- Gilead Advancing Access: The company that makes Truvada, Gilead, offers a program called Advancing Access that helps those who are insured, uninsured, or underinsured get access to the medication. When feasible, the program can help participants look for ways to reduce the cost of Truvada.
Another option is to discuss Truvada’s cost with a doctor, who may be aware of local assistance organizations that can help with the expense.
To sum up, Truvada is included in all Medicare Part D drug coverage tiers.
But the individual must still pay for things like the plan’s premium, as well as any copayments or other out-of-pocket charges.
Some programs can help make medicine more affordable and easier, which is a good thing.
Does Medicare cover prep?
Medicaid and Medicare should also pay for PrEP because other insurance policies widely cover it.
Some programs offer PrEP at no cost or a much-reduced price.
PrEP navigators are available at many facilities and can direct patients to the appropriate services. Inquire about the available choices.
Does insurance cover descovy?
Descovy and other PrEP (Pre-exposure Prophylaxis) drugs are typically covered by health insurance. Medicare and Medicaid may cover Descovy. For those who cannot take Truvada because of renal disease or another medical condition, Descovy is typically covered.
Does Medicaid cover prep for HIV?
Health plans and Medicaid programs typically cover PrEP.PrEP must be provided at no cost to patients by health insurance providers by the provisions of the Affordable Care Act. There is a complete ban on billing for PrEP or the necessary follow-up appointments and lab work.
Does Medicaid cover Truvada?
Medicare supplement insurance, or Medigap, is designed to help cover medical expenses not covered by Original Medicare.
They, like Medicare Parts C and D, are provided by independent insurance agencies. As a result, the precise advantages offered by various plans vary.
Before 2006, certain Medigap policies did cover the cost of medications. On the other hand, this is not covered by any Medigap policies purchased after 2006. This means that the more modern plans will not pay for your Truvada Medicare expenses.