Through advancements in medication, people living with HIV/AIDS are living longer and staying healthier. Unfortunately, the medical costs can be very high.
There are programs that will help with HIV/AIDS medications. This one is called U.S. Advancing Access, from Gilead. The program focuses on hepatitis and HIV medications.
U.S. Advancing Access Program Medications
Complera Tablets 300mg
Emtriva Capsule 200mg
Hepsera Tablet 10mg
Viread Tablet 300mg
How to Qualify
To qualify for this program, you must have an income at or below 300% of the Federal Poverty Level. You must be able to prove your income by sending in financial documents. You must also prove residency by sending in a copy of your driver’s license, a bank statement with your information, or a utility bill with your name and address.
The easiest method to prove your financial situation is to send in your filed tax documents from the most recent year. If you didn’t file taxes last year or if your income last year was more than 300% of the Federal Poverty Level, you can send in current proof of income.
Depending on your situation, current proof of income could include:
W-2s, 1099s, or tax transcripts
2 consecutive paycheck stubs that are dated within the last 60 days with the pay period and deductions
Workers comp statement
Unemployment check stubs, award letter, or statement
Social Security award letter
Letters describing your unique financial situation; including zero income. The letters can be written by either you or your doctor but, either way, they have to be notarized.
In the event that your income is too high, but you still can’t afford your medication, don’t despair. You or your doctor can write an appeal letter that outlines your financial situation and you can submit it with your application, before even being denied.
You will need to gather examples of your expenditures - you can use any paid medical or prescription costs. You should be able to get printouts from your doctor’s office, your pharmacy, and any medical supply stores from which you’ve made purchases. You can also use your rent or mortgage and possibly even your utility bills as examples.
If you have any question about what U.S. Advancing Access might accept, give them a call at 800-226-2056. It’s better to spend a few minutes on the phone now than to get denied and scramble to appeal later.
If you are HIV positive, you might already be familiar with your state’s AIDS Drug Assistance Program (or ADEP). If your income is at or below 200% of the FPL and you are HIV positive, the U.S. Advancing Access program requires that you send in an ADAP denial letter.
This means that you would need to apply to the ADAP program and then be denied assistance by that program. You can send in the denial letter with your application to the U.S. Advancing Access program or you can apply to both programs around the same time.
Assuming you meet all the other qualifications, Gilead will admit you into the program for a 90 day period, awaiting your ADAP status. If ADAP accepts you, they should cover your medications but, if they don’t, you might qualify for the U.S. Advancing Access program.
What if You Have Insurance?
Pretty much all forms of insurance are accepted under certain conditions, except Medicaid. If you are Medicaid eligible (meaning your household income is below 100% of the FPL), you will need to apply for and be denied by Medicaid just as in the ADAP example in the paragraph above.
If you have no insurance or if you have insurance with no prescription coverage, you will be accepted with no additional work.
There is a good chance that U.S. Advancing Access will accept you, even if:
Your medication or the medication’s drug class isn’t covered
Your medication isn’t covered due to a pre-existing condition
Your coverage is exhausted
You have veteran’s benefits
You are in the Medicare Part D “Donut Hole”
U.S. Advancing Access will run a benefits verification based on the insurance information that you’ve provided on your application and make their decision from there.
If you have prescription coverage but your co-pay is too high for you to afford, you will need to provide supporting documents proving this circumstance.
Ask your pharmacy for a printout of your past expenditures and write a letter that demonstrates that your co-pay is too high. If U.S. Advancing Access agrees, they will refer you to a co-pay assistance program.
Remember to send a copy of the front and back of your insurance card (or Medicare Part D card) to aid in the verification process.
To get an application, you can click here: https://services.gileadhiv.com/content/pdf/gilead_enrollment_form.pdf
You can also sign up for the U.S. Advancing Access program online. Just go to: https://www.gileadadvancingaccess.com/
If you print out the application, you will need to fill it out as neatly and completely as possible. Make sure your doctor does the same. Small written errors on the applications are often the reason behind application denials.
Don’t be afraid to call and ask for advice with any questions about the application or the supporting documents you. Call the program at 800-226-2056 or check out the website: https://www.gileadadvancingaccess.com/. It will save you so much time and trouble to ask questions at this point rather than after making a mistake.
When everything is gathered and ready to go, fax it to the U.S. Advancing Access program at 800-216-6857.
What Happens Next?
It should take the program two weeks or less to determine your eligibility.
If you are accepted into the program, Gilead will send you a prescription voucher. Take that voucher and a prescription from your doctor to your pharmacy and you will receive your medication for free.
You will get a 30 day supply each time. The earliest you can receive another 30 day supply is 25 days after the last one was received. You should be able to get a full year’s worth of medication if you keep up with the refill dates.
To continue in the program you should re-apply a couple months before your enrollment ends. Be sure to keep in touch with the U.S. Advancing Access program so you can stay ahead of any changes they might make to their program.
When it comes to prescription assistance programs, there are a lot of rules you need to know, a lot of red tape to cut through, and not a lot of people who are qualified to help you.
Patient assistance programs often change their guidelines and application forms without announcing it. They offer the medication for free but red tape and human error can keep you from getting the help you need.
Most doctors and pharmacists are either unfamiliar with prescription assistance programs or they just don’t have the time and man-power to dedicate to them. Plus, without specialized software, they would have to learn each patient assistance program from scratch.
There are websites (like this one!) that can help you sign up for prescription assistance programs by yourself. This is a great resource for people who are organized and not afraid to spend some time doing research.
Unfortunately, if you are taking more than one prescription medication or if your health is poor, you might need more than written instructions to help you.
In that case, where can you turn?
Prescription Lifeline has helped people just like you get their prescription medication for 15 years. We have the experience and the technology to make sure you get assistance from whatever patient assistance program you qualify for.
Prescription Lifeline has developed unique software to keep all the forms, medications, and rules for each patient assistance program. This gives us an unmatched level of accuracy and speed.
We are dedicated to making sure that everyone has access to the health care they need. As part of Prescription Lifeline’s patient advocacy, we will not only help you get into patient assistance programs, we can evaluate your Medicare plans and make sure you are getting the best price for the best coverage.
Medicare is another program that is helpful but often frustrating. You can look over the Medicare website (https://www.medicare.gov/) and still feel overwhelmed or confused. After hearing our Prescription Lifeline members talk about their Medicare problems, we decided to expand our advocacy services to include Medicare plans and supplements.
Your health is your greatest resource. The patient advocates at Prescription Lifeline know that and work their hardest to make sure you are getting your prescriptions and getting access to health care without overpaying.
Contact Prescription Lifeline at www.PrescriptionLifeline.org or call and speak to a patient advocate at 1-888-331-1002. Whether you need help with prescriptions or you’re just curious about getting the best price for your Medicare coverage, Prescription Lifeline is here to help.