Academy Exchange

  • 1.  Cabenuva

    Posted 06-01-2021 17:49
    Having some difficulty navigating our first patient through the Cabenuva process. We went through ViiV Connect to mitigate insurance issues, the patient was approved and started oral lead-in therapy. PA was approved through his medical benefit. We have recently received contradictory info through ViiV Connect regarding acquisition of medication and appropriate process for billing insurance. We are now being told the specialty pharmacy they directed us to cannot bill his medical benefits.
    Has anyone had similar experience and if so, what was the resolution? I have reached out to our rep and have a phone call pending.
    Thanks!

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    Roxanne Underwood FNP-BC, AAHIVS
    ETSU HIV Center of Excellence
    Johnson City TN
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  • 2.  RE: Cabenuva

    Posted 06-02-2021 15:06
    I found the ViiV specialty pharmacies not very good. Other than getting the Vocabria for oral lead-in, I have been using the Walgreens Specialty pharmacy in my city.  They put through the order and get it approved, and then get the Cabenuva delivered to their pharmacy from their supplier.  They then deliver the med to my clinic for administration.  They can tell me immediately when I send them an electronic prescription if it will go through by the insurance.
    Hope that might be helpful.
    Gary

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    Gary F. Spinner PA,MPH,AAHIVS
    Medical Director
    Ryan White HIV/AIDS Program
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
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  • 3.  RE: Cabenuva

    Posted 06-02-2021 19:31
    Thank you for starting this conversation.  Unfortunately, I don't have all that much to offer, but will be following.

    We had similar issues with the buprenorphine implant (sublocade) and the added layer of complexity with that particular med is that it is also part of a REMS program.

    It seemed like the clinic is supposed to buy the med, administer it in a clinic setting and bill the medical benefit "on the back end," or in other words, not in real time.  An insurance company won't tell you how to appropriately bill the med either.

    The billing, the work flow of clinic, and optimal patient selection have all combined to where we haven't pursued this therapy, yet.

    Best,
    Alex
    Pharmacy