TREATMENT ISSUES, Volume 6, Number 5; The Gay Men's Health Crisis Newsletter of Experimental Therapies - May/June 1992
Loren Couch

These programs are similar in a number of ways. For instance, each classifies its members in three ways:

1) those with insurance, 2) those without insurance, and 3) those with Medicare or Medicaid.

Drugs are then priced according to the ability of each member to pay, as defined by the three categories. Therefore, members with health insurance will pay the highest price, and those without insurance who must pay out-of-pocket will be charged the lowest price. Of course, every insurance policy is different, so it is important to review personal insurance policies before using a mail order pharmacy. Policies may have certain contingencies like drug limits, maximums (no reimbursement after a certain amount has been paid), or exclusions (drugs or therapies that are not reimbursable). A low lifetime maximum policy that only allows repayment at, say, $5,000, might warrant using mail order pharmacies and paying directly out-of-pocket to receive the most medication for the least cost. None of the mail order pharmacies surveyed is a non-profit organization.

How Mail Order Works

Mail order pharmacies bill the insurance company directly and accept whatever amount the insurance company pays. If the full cost is not covered, the pharmacy does not seek any payment from the individual member. This means no out-of-pocket costs and a 20%-30% discount on medications benefit the participating individual with insurance. Payment of the deductible (amount required out-of-pocket before the service kicks in) is still the responsibility of each member, but some plans offer different methods for making such payment. For instance, American Preferred Plan has a frequent-buyer program that awards bonus points to members. Bonus points can be applied toward payment of deductibles. My Choice Plan, Community Prescription Plan, and University Pharmacy Health Center work with the member to devise a payment plan for the deductible.

For individuals without insurance, each plan seeks to provide medications at the lowest cost. It is advisable to call around for the lowest price. Each plan offers assistance for non-insured members in locating drug assistance programs, like the AIDS Drug Assistance Program (ADAP), to pay for needed medications. Finally, for participants on Medicare and Medicaid, federal and state policies do not allow use of out-of-state mail order pharmacies.

American Preferred Plan (APP), (800) 227-1195.

Established in 1988 by Ron English, APP is a free membership plan. For those with insurance, APP accepts any amount the insurance company pays. Members are not obliged to pay the amount not covered. For individuals without insurance, APP will provide assistance in locating possible sources of free medication. Services provided include no-cost prescriptions, prompt free delivery (UPS), no filing of insurance forms, and 24-hour telephone service. Members can also get automatic refills.

APP works with the AIDS Treatment and Data Network (ATDN), where medications may be delivered for easy pick-up. APP has a frequent buyer program that awards points to members. These points can be redeemed in the form of payment of a deductible, the purchase of merchandise, or a designated contribution to any not-for-profit organization. (Editor's Note: GMHC is one of the organizations to which members can designate a donation.)

My Choice Plan, (800) 336-7310.

This program also offers free membership for prescriptions by mail. My Choice Plan has been around for over 20 years. The staff of My Choice Plan also provides assistance in helping members obtain necessary medications. If a member has no insurance, the plan will provide information on obtaining medication through compassionate use, Treatment IND's, or a manufacturer's assistance plan. Non-insured members are also able to obtain drugs at cost plus shipping charges. One unusual aspect of My Choice Plan is that it accepts New York or New Jersey Medicare. With each order, My Choice Plan sends free condoms.

Community Prescription Service (CPS), (800) 677-4323.

A gay, lesbian and HIV-positive owned and operated plan that began in 1991. In addition to the convenience of a mail order pharmacy, CPS has a drug card that is good at 3,500 pharmacies around the country. With this card, a member who needs medication and cannot wait for the mail, can obtain small amounts of medication from participating pharmacy for only $4.00. Every three months, CPS also provides members with an information packet from national gay and activist publications. CPS stresses customer service. Members are encouraged to evaluate the service they receive. Pharmacists are available to answer questions about medications and related concerns.

University Pharmacy Health Center, (800) 487-7115.

UPH offers the convenience of a mail order pharmacy and a research library on drugs and nutrition from which members can request copies of specific articles.

Stadtlanders Pharmacy Lifetime Program, (800) 238-7828.

This plan accepts insurance information from each customer and then verifies the coverage separately. If insurance pays 80% of the billed amount, Stadtlanders takes that amount as the total. However, for applicants with insurance plans that reimburse less than 80%, Stadtlanders offers out-of-pocket billing. Under out-of-pocket billing, members may use credit cards to pay for medications. Clients need to order $200.00 of drug per month, rendering the plan best for maintenance medications. The plan also incorporates families, so that one member needs to match the $200.00 and other family members can have prescriptions filled at any cost per month. Medication, however, has to be sent in the same package to the same address.

Deductibles with Stadtlanders are handled with a billing program. The company employs a social worker for clients with financial limitations. Medicaid is accepted from the following states: Pennsylvania, Virginia, Idaho, Illinois, Indiana, Iowa, Kentucky, Nebraska, and New Mexico. New York and New Jersey Medicaid are not accepted. The pharmacy offers an automatic refill option after the first prescription is filled. If approved by a doctor, the pharmacy sends a 30 day supply. Stadtlanders has 30 pharmacists to take calls and discuss medication and doses.

Conclusion

It is important to assess personal insurance situations before becoming a member of any of these important optional mail order pharmacy plans. For people with HIV/AIDS, these plans may help alleviate some of the burden of treatment costs and help make financial planning more feasible. For more help with assessing insurance plans, call the GMHC financial hotline at 807-7519.

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