List of HIV Drug Co-Pay and Assistance Programs

Photo Credit: Jeff Kaufman/Getty Images

While access to treatment has increased for people living with HIV since the implementation of the Affordable Care Act (ACA) in 2014, the cost of antiretroviral therapy remains a challenge—even a barrier—for many. According to the non-profit Fair Pricing Coalition (FPC), some insurers have tried to skirt the law by making HIV drugs either unavailable or more expensive than other chronic medications prescribed as essential by the ACA.

In some cases, insurers have excluded first-line antiretrovirals from their formularies, while others required patients to pay a percentage of the drug’s cost rather than the standard flat fee.  As a result, therapies that are meant to be accessible and affordable are hitting some patients hard in the pocketbook.

Co-Pay and Patient Assistance Program (PAP) Eligibility

In the effort to ensure affordable access, the FDC has negotiated co-pay and patient assistance programs (PAPs) with most every HIV drug manufacturers. Both programs provide assistance to patients who meet eligibility criteria based on the annually updated Federal Poverty Level (or FPL). The criteria for inclusion varies by program, with some PAPs, for example, providing access to those with incomes twice the FPL while allow membership at 950% of the FPL. Additionally the FPL is adjusted by family or household size. The FPL Guidelines are available here for the 2016 calendar year.

While co-pay programs assist with the insurance co-payment of each individual drug, PAPs work to provide qualified low-cost to free medications. In most cases, verification of income is required, usually in the form of a federal income tax return.

A more recent development has been the establishment of the Common PAP Application, an initiative coordinated through the U.S.

Department of Health and Human Services to streamline the application process. (Please note, however, that while the application helps reduce the amount of paperwork associated with registration, the form does still need be sent to each drug manufacturer individually.)

DrugCompanyContactProgram TypeProgram Details
AptivusBoehringer Ingelheim800-556-8317 or apply online at www.pparx.orgPAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
AtriplaGilead Sciences877-505-6986 or product websiteCo-PayCovers first $400 per month of the patient's co-pay.
 Gilead Sciences

866-290-4767 or product website

PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
AtriplaBristol-Myers Squibb866-784-3431 or product websiteCo-PayBenefit equals an amount up to $6,800 annually.
 Bristol-Myers Squibb866-290-4767 or product websitePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
CombivirViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
CompleraGilead Sciences877-505-6986 or product websiteCo-PayCovers first $400 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
CrixivanMerck & Co.800-850-3430 or Isentress websitePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL.
EdurantJanssen Therapeutics866-961-7169 or product websiteCo-PayCoverage up to 100% of co-pay up to $7,500 maximum benefit.
 Johnson & Johnson Patient Assistant Foundation800-652-6227PAPCovers people not qualified for other assistance with incomes up to 200% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
EmtrivaGilead Sciences877-505-6986 or Truvada websiteCo-PayCovers first $200 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
EpivirViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
EpzicomViiV Healthcare888-281-8981Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
EvotazBristol-Myers Squibb888-281-8981or product websiteCo-PayBenefit equals an amount up to $6,800 annually.
 Bristol-Myers Squibb888-281-8981 or apply onlinePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
FuzeonGenentech Access Solutions877-757-6243PAPCovers people not qualified for other assistance with incomes up to 950% of the FPL.
GenvoyaGilead Sciences877-505-6986 or product websiteCo-PayCovers first $400 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
IntelenceJanssen Therapeutics866-961-7169 or product websiteCo-PayCoverage up to 100% of co-pay up to $7,500 maximum benefit.
 Johnson & Johnson Patient Assistant Foundation800-652-6227PAPCovers people not qualified for other assistance with incomes up to 200% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
IsentressMerck & Co.855-834-3467 or product websiteCo-PayCovers first $400 per month of the patient's co-pay.
 Merck & Co.800-850-3430 or product websitePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL.
KaletraAbbvie800-222-6885 or product websiteCo-PayCovers first $200 per month of the patient's co-pay.
 Abbott Patient Assistant Foundation800-222-6885PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
LexivaViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
NorvirAbbVie800-222-6885 or product websiteCo-PayCovers first $50 per month of the patient's co-pay.
 Abbott Patient Assistant Foundation800-222-6885PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
PrezistaJanssen Therapeutics866-961-7169 or product websiteCo-PayPatient covers first $5 of co-pay and Janssen covers the rest.
 Johnson & Johnson Patient Assistant Foundation800-652-6227PAPCovers people not qualified for other assistance with incomes up to 200% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
PrezcobixJanssen Therapeutics866-961-7169 or product websiteCo-PayCoverage up to 100% of co-pay up to $7,500 maximum benefit.
 Johnson & Johnson Patient Assistant Foundation800-652-6227PAPCovers people not qualified for other assistance with incomes up to 200% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
RescriptorViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
RetrovirViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
ReyatazBristol-Myers Squibb888-281-8981 or product websiteCo-PayBenefit equals an amount up to $6,800 annually.
 Bristol-Myers Squibb888-281-8981 or apply onlinePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
SelzentryViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
StribildGilead Sciences877-505-6986 or product websiteCo-PayCovers first $400 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
SustivaBristol-Myers Squibb888-281-8981 or product websiteCo-PayBenefit equals an amount up to $6,800 annually.
 Bristol-Myers Squibb888-281-8981 or apply onlinePAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
TivicayViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
TriumeqViiV Healthcare877-844-8872Co-Pay Covers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
TrizivirViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
TruvadaGilead Sciences877-505-6986 or Truvada websiteCo-PayCovers first $200 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
 Truvada for PrEP Medication Assistance Program855-330-5479Co-PayCovers up to $200 per month of the patient's co-pay for HIV-negative individuals using Truvada for preventive pre-exposure prophylaxis (PrEP)
ViraceptViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
ViramuneBoehringer Ingelheim800-556-8317 or apply online at www.pparx.orgPAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
VireadGilead Sciences877-505-6986 or Truvada websiteCo-PayCovers first $200 per month of the patient's co-pay.
 Gilead US Advancing Access Program800-226-2056PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.
ZiagenViiV Healthcare877-844-8872Co-PayCovers first $200 per month of the patient's co-pay.
 ViiV Healthcare Patient Assistance Program877-784-4842PAPCovers people not qualified for other assistance with incomes up to 500% of the FPL, but will make exceptions for some patients who are Medicare Part D clients, or under-insured people unable to afford co-pay, deductibles, or out-of-pocket drug payment.

Sources:

Ryan, B. "Obamacare: No So Affordable for People with HIV and Hep C.” POZ Magazine; published March 1, 2014.

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