Is anyone taking TAF(Vemidly) in the US. Does insurance cover it. I was looking at the prices and Vemidly is crazy expensive.
Hi @Anonymous63,
I take Vemlidy but it is fully covered by my insurance. Because Vemlidy was approved not long ago and still under patent it makes it cost more. Entecavir and TDF is much less expensive since they have generic versions. Try goodrx they sometimes have affordable prices. Thanks, Bansah1.
Hello @Anonymous63,
I take TDF, and it’s been working great so far. TDF, entecavir, and their generic versions are all that my healthcare will cover due to them being less expensive. The effects of TDF from my personal experience is just as good as Vemlidy. I will have to pay 20% out of pocket soon because my girlfriend is losing her job soon. Perhaps tough times ahead for the economy.
Cheers.
How much is Vemlidy in the US by the way?
My daughter is on TAF but is in a study. The study is about to end so her GI checked and it will be covered under our insurance.
Karen
Vemlidy prices from my search ranges between $1300-$1800 per 30 tabs bottle (a month’s supply). Each insurance group will have a different price same as the pharmacies. Hopefully, a generic version will become available soon when the patent expires. Thanks, Bansah1.
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Hi @Anonymous63 and others,
There has been some discussion of this topic in other threads. In particular this post by @Suwang88 might be useful:
Cheers,
Thomas
Vemlidy prices from my search ranges between $1300-$1800 per 30 tabs bottle (a month’s supply).
Just to compare, in Germany, it costs 330 EUR (around 360 USD) if you’re insured (virtually everyone is insured in Germany), for the same 30 tabs bottle / month supply.
If you’re not insured (i.e. an overseas tourist who lost his Vemlidy and got a prescription from a local doctor), the cost would be 920 EUR (around 1000 USD).
U.S health care cost and medications are likely the most expensive among Western countries. The insurance industry and pharmaceutical companies rule here, they decide what price one pays and what you get. The government has limited control and doesn’t set prices. The market is dominated by private insurance companies and big pharma who charges whatever amount they want. We spend more than any country on health care but we are also the sickest nation. That tells you something, right? Great conversation. Thanks, bansah1.
Yesterday, I heard another doctor talk about a way to get TAF that I had not considered.
TAF is part of Descovy a comibnation medicine used for PreP (prevention of HIV). This ID doctor said that he has used it for his patients with HBV and it is always covered by insurance because there’s no real way to verify that it’s not being used for HIV prevention. To me, it seems crazy that anybody without HBV can get a HBV medication without having to go through testing like people with HBV have to.
If it’s that easy for them to access HBV, it should be equally accessible for people with HBV where it is really effective in suppressing the virus!
Of course if you have HBV and take medication, it is important to take it daily to prevent a flare (and potentially resistance though we haven’t seen that yet TAF) and it is good to get bloodwork to see the effect of the medicine. But for those who want to take medication, I believe we should be making it much easier than it currently is.
Hi @Suwang88,
I have heard that too. I spoke to a provider and he shared that its been challenging with getting antivirals for HBV patients through some insurance companies. He shared that he prescribed Entecavir for a patient, it was denied. He appealed the denial and it was denied again. He switched to TDF, and the insurance will not pay for that either. The only suggested alternative was Truvada. He tried appealing this as well and it got denied. He ended up prescribing the Truvada which the insurance covered without any issues. I was surprised by this, hearing that some patients have to fight the system just to get their antivirals approved. It makes no sense, but sadly that is what is happening.
Bansah1.
Hello, as @Bansah1 mentioned in the previous post about Vemlidy, CVS and Aetna have resumed covering Vemlidy through their commercial plans (starting December 14th, 2023). Plans and insurance providers often change their mind coverage and pre-authorization on and off (unfortunately), so for those shopping for insurance, it is important to go over their formularies and make sure they are cover Vemlidy or other antivirals. It is not an easy task to navigate health insurance plans here in the U.S. but an important step if the person has the option to choose which plan, which is not always the case.
Hi all & @ThomasTu
You are doing very help
I am on TAF last 3 years and before to that I was on TDF for 7 years. No any complications. Now moving to US - And I come to know that TAF is very expensive and not covered by insurances. In that case What the options for me ? Safe to switch back to TDF? Will doctor do that recommendation or will they want to keep on TAF?
Hi @Hello,
I will recommend you work with a provider on this issue especially dealing with insurance in the US. TDF, TAF and Entecavir are all available in the US. As you rightly mentioned due to the cost of TAF not every insurance company covers it. Talk to your provider based on your insurance and they can guide and provide direction here. Usually, insurance will provide a list of alternatives, so in this case it might be entecavir or TDF based on the insurance. Your doctor will then decide which of the alternatives covered by your insurance is best for you to switch to. I hope this is helpful.
Thanks alot Bansah1. You said your insurance covers TAF. Can I buy that insurance from open market ?
is switching from TAF back to TDF considered safe ?
It depends on your immigration status. Not everyone is able to buy insurance. It also differ from state to state. Each state has its own requirements for its insurance market. And yes, you should be able to switch back to TDF if that is what your doctor recommends. Thanks, Bansah1
This has mostly been investigated in the context of HIV PrEP, when changing from TAF-containing combinations to TDF-containing combinations
(Switching from TAF to TDF leads to weight loss | aidsmap)
Switching from TAF was also associated with reductions in total cholesterol, total cholesterol-HDL cholesterol ratio and triglycerides, especially in people who switched to either TDF or dolutegravir/lamivudine.
No adverse effects were reported in the reference studies in that article that I could see.
Thomas
If you have commercial insurance (not Medicaid, not Medicare), Gilead has a copay coupon program which can help with TAF coverage. You just go on line and apply for it and then give the code ot the pharmacy. Try that first. If that doesn’t work, it is safe to switch to either TDF or ETV.
Thomas brings up a point about PreP which reminds me that one can get TAF as part of HIV PreP and insurance does cover it, it’s a quirk in the system. Actually, lets just call it HBV descrimination, but could be a way to get TAF covered by insurance.
Check out this article about how PreP treatment must be covered by insurance companies (kind of makes me mad that nobody is saying this about HBV treatment).
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