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Hello!

  • 1.  Hello!

    Posted 22 days ago
    Thank you to everyone, this has been SUPER helpful!

    My name is Erika Shea, I am a FNP with HIV specialty in Philadelphia PA.

    I have an insurance question: A new patient from Massachusetts was told she cannot get PA insurance to cover her ART until her case is closed in MA. She applied 2 weeks ago, her case in MA had already been closed per her online account- which she is able to show me on her phone. She is told by PA welfare that they must receive a letter from MA welfare regarding the closure of her benefits. She is also told that MA cannot mail such to Phila PA address, must be a MA address, but she has no one in MA who can receive this for her.

    Does anyone know a quick way around this dilemma? Seems to me that there would be an electronic way to get her benefits started in PA, she is already several months without her bictarvy.

    Thank you,
    Erika


  • 2.  RE: Hello!

    Posted 22 days ago
    This should make her eligible for patient assistance thru Gilead patient assistance program, advancing access.  Generally with those "denial" letters that makes it easier for them to help.  It's at least worth the time of a phone call to see if they have suggestions.  Sometimes they can help advocate for patients as well.

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    John Phoenix
    Las Vegas NV
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  • 3.  RE: Hello!

    Posted 22 days ago
    Erika,

    I can't really provide any help regarding your actual question of MA and PA coverage. I'm hopeful some of our MA-based colleagues can help with that though.

    But you can most definitely get her medications, specifically Biktarvy. Based on what you're describing, it sounds like the patient is completely uninsured. If you go to Gilead's Advancing Access website (gileadadvancingaccess.com), click in the upper right "Uninsured 24/7 Support" From there you can enroll via phone or online. I generally do online because I can take a screen shot of the billing info. And I go through the Patient portal instead of the HCP portal, but that's personal preference cause I didn't want to sign my clinic up for an account. You'll need to fill info out of behalf of the patient, so make sure you have permission and/or have the patient with you and fill it out together. You'll need to submit an income estimation. 

    Then the patient can get access to Biktarvy for free for 30 days using the billing code they provide - just call the preferred pharmacy and give them the details. After 30 days, the patient may qualify for PAP for the remainder of the year but that will require no insurance and offical proof of income - to my knowledge at least. Or, and what I use this program for, that 30 days allows enough time to get enrolled with your state's Medicaid and ADAP programs. 

    Hope this helps!

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    Katy Garrett
    Portland ME
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  • 4.  RE: Hello!

    Posted 22 days ago
    Contact your Gilead rep and get her samples.  Or contact your colleagues where you are now.

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    James Adams
    Rancho Mirage CA
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