⭐First Things First⭐
If you are starting Descovy and will be using private insurance to pay for it, you should check with your insurance provider if you have a “cap” on your insurance plan as this could impact whether you can get Descovy for free.
What is an insurance cap?
An insurance cap is the maximum dollar amount that a health insurance plan will pay for covered health care benefits (e.g. prescription drugs) in a specified period. Typically, an insurance cap is an annual maximum; for example, it will cover $15,000 worth of prescription drugs in a year. If an individual reaches their insurance plan cap, their plan will no longer provide coverage and the individual is responsible to pay out-of-pocket for all costs over and above the cap.
Do all insurance plans have caps?
It is estimated that 60-70% of plans do not have caps on prescription drugs (and therefore provide unlimited coverage) while 30-40% of plans do have prescription drug caps.
How might an insurance cap impact me?
Descovy is an expensive drug. Even though more than 95% of people with private insurance pay $0 for Descovy, your insurer still pays a lot for it – about $9,000 a year. If you have an insurance cap, Descovy could use up some or all of your cap.
There are a few scenarios:
- You have a large cap (e.g. $20,000+): Your cap should cover Descovy and any other prescription drugs you might be on.
- You have a medium-sized cap (e.g. $10,000): Your cap will cover Descovy (which requires a cap of about $9,000) but you would not have much room for other prescription drugs.
- You have a low cap (e.g. $5,000): Your plan would cover $5,000 of the cost of Descovy, but the other $4,000 would need to be covered by you.
How large of a cap do I need to get Descovy for free?
Descovy costs about $950 a month. Most insurance plans cover 80% of this cost, so $760. Freddie helps you get the other 20% covered through co-pay assistance programs, so you pay $0. But the insurer still pays $720 a month. Over the course of a year, this equals $9,120.
I have a cap but I still want Descovy. Can Freddie help me?
Freddie is working on a financial assistance program for people with smaller caps (e.g. less than $9,000). We hope to have more details on this soon.
If your cap is large enough (e.g. >$9,000) and you aren’t on any other prescription drugs, you should be all good to go!
How do I check if my plan has a cap?
We wish we could check this for you, but your insurer wont share this information with us for privacy reasons. So you will need to call them directly.