9 Best Ways to Keep Genvoya Cost Manageable

Medically reviewed by, Russell Braun RPH

Genvoya is a medication used to treat HIV infection. It is a combination of four different medications put together in one pill. The medication has been quite effective at controlling HIV so your immune system can stay strong.

However, the cost is off the charts!

The following active ingredients are found in Genvoya:

Elvitegravir 150mg
Cobicistat 150mg
Emtricitabine 200mg
Tenofovir alafenamide 10mg

What does Genvoya treat?

Genvoya is not a cure for HIV, but it can substantially lower the number of copies of the HIV virus in your body. Please keep in mind this medication does not prevent you from spreading HIV to other people.

HIV has two main viral strains, HIV-1 and HIV-2. HIV-1 is by far the most widespread form of HIV. Genvoya is used as an initial treatment for HIV-1 in adults. Some drugs used to treat the infection are only used after initial treatments have failed.

Another benefit if Genvoya is that this is a single table regimen. That means you only have to take one tablet which gives you four drugs at the same time. Instead one Genvoya daily with food and you are done taking HIV pills.

Previous HIV treatments involved several different individual drugs that had to be taken different times of day. This plus the fact that they needed to be spaced out from other drugs or food, made taking the medication difficult for patients.

Genvoya vs Stribild

These drugs both manufactured by Gilead are very similar. The only difference is the form of tenofovir. Genvoya contains tenofovir alafenamide and Stribild contains tenofovir disoproxil fumarate.

Stribild was introduced first and had the older form of tenofovir in it. Genvoya is newer and has wider use because it has been claimed to cause less kidney and bone problems.

How much does Genvoya cost per month?

According to GoodRx, Genvoya costs about $3070 for a 30 day supply if you paid cash. That would result in an annual cost of $36,840!

Clearly you will need a plan for how to pay for Genvoya if it is prescribed for you. Paying $36,000 per year for most people is totally out of reach. Prices of older HIV treatments from Gilead have recently gone up. The manufacturer wants the more effective Genvoya to be used over older lower cost treatments.

You need to understand the benefits of this drug in treating HIV and if the cost makes sense for your situation.

1. Is there a generic for Genvoya?

There is no generic for Genvoya presently available.

In the early days of HIV treatment there were multiple pills required to get the maximum benefit and keep the virus at bay. The drugs also had numerous side effects and were difficult to keep straight of what should be taken when. This sent the manufacturers back to the drawing board to see if they could combine drugs into fewer pills.

However, each time a new combination drug is released, the patent life is extended. This means that the combination drugs will stay brand for years to come.

Tenofovir

The tenofovir component in Genvoya, has been widely used in many combination HIV medications. It has been very effective in treating HIV. Tenofovir is one of the drugs in the majority of HIV treatment regimens in the U.S. today.

Some AIDS activists say that Gilead waited to come out with tenofovir alafenamide until older forms of tenofovir had almost lost their patent. Even though the new form is said to have less side effects.

Genvoya was originally released in the U.S. in 2015 and a generic is not expected anytime soon. Aside from the original patent there have been numerous lawsuits by Gilead for other HIV drugs they create to extend patent life. Genvoya will not be any different.

2. Formulary

You need to confirm with your insurer if Genvoya is on formulary. If it is on formulary is it a preferred medication? The more preferred the better your copay will be.

While most insurers do cover Genvoya, some may want you to have tried Stribild first as it is lower cost.

Prior Authorization

Regardless of the formulary status your doctor may still have to complete a prior authorization (PA). A PA is a requirement for approval to pay for a medication by many health insurers. They will require your doctor to complete paperwork to ensure medication is being used properly. Without the PA your insurance will not pay for the medication.

Step therapy

A part of some PA’s is step therapy. Since older HIV treatments are effective and are much lower cost than Genvoya, you insurer may have a step therapy policy in place. They would want to know per your doctor if you had tried and failed some older less expensive medications. Your doctor will need to document this as part of the prior authorization process.

3. Therapeutic Alternatives

Regardless of your formulary or PA requirements you should ask your doctor about therapeutic alternatives. Much like the insurer may put a step therapy in place, this is you looking out for your wallet.

Older HIV drugs that have generic options available are still highly effective. They are also safe, don’t believe what the manufacturers seem to push, that the side effects of the older medications make them extremely dangerous.

Side effects exist for any drug brand or generic. As long as you are documenting your experience with your medication and keeping your doctor informed the side effects can be managed.

Numerous potential therapeutic alternatives for combination drugs like Genvoya exist. Talk to your doctor about what might be the best combination for you based on your circumstances.

4. Samples

Ask for samples as soon as you confirm Genvoya is for you. As with any brand name drug you are prescribed you should always ask for samples. The reason is that the sample will give you a chance to determine if you can tolerate this drug before you actually have to pay for it.

Most doctors who would be treating you for HIV should have samples available as the manufacturer is more than willing to provide them.

Read 5 reasons for bullet journaling medication effects to learn more about what to track while you have samples. This will help you determine if you should continue taking Genvoya or ask your doctor for another treatment.

5. Patient Assistance Programs (PAP’s)

Patient assistance programs are your next step if Genvoya is being prescribed for you. The PAP program is put on by Gilead Sciences the manufacturer of Genvoya and provides medication at low or no cost.

To qualify for this program you must meet the following criteria:

A resident of the U.S.
Uninsured
Under insured, meaning your insurance does not cover this drug
Income below 500% of Federal Poverty Level (FPL)

You can print the form off of the NeedyMeds.org website. Search under patient savings and then Genvoya and look for PAP programs. One you complete the application and income verification you will take the form to your doctor for a signature. Once faxed or mailed in a decision will be provided in 3-5 business days.

If you are below or slightly over the 500% of FPL always apply!

Needymeds has an FPL calculator you can use to determine where you are based on your income and number of people in your household. If you qualify this would be free medication, no question asked. Please take the time to figure out if you should apply and if you are close do so.

If you do qualify you will be enrolled for a year. After the year is up you have to reapply and provide updated income information.

6. Copay coupon card

Copay coupon cards are provided by pharmaceutical manufacturers to assist patients with insurance to be able to afford their out of pocket expenses.

That could be a copay, coinsurance or deductible. The coupon is good for up to $7200 per year. Therefore, if you have a high deductible health plan this may pay for the first few fills.

It is important to keep in mind Genvoya costs $36,000 per year!

Important things to remember

Only valid if you do have insurance
You can’t use this card if you have any federal or state insurance. Examples: Medicare, Medicaid
Medicare Part D patients who are in the coverage gap DO NOT qualify either
Gilead retains the right to keep information about your prescription fills

Copay accumulator

If you have a high deductible health plan (HDHP) you may have a copay accumulator. What is that you ask?

Copay accumulators are where your insurance tracks how much money you receive from drug manufacturers in the form of copay coupon cards. That amount is NOT applied to your deductible. Meaning you would still have to pay the amount the Genvoya card pays up to $7200 in order to meet your deductible.

This can be a rude awakening if you fill Genvoya two times with a copay coupon card paying the full $3070 each time. Then on the third fill the card is exhausted and you are still responsible for your full deductible amount!

7. Medicare Extra Help

For patients who are low income and have tried other ideas provided here there is another option. Extra help is a federal program that helps patients with Medicare through a low income subsidy.

Extra help is like it’s name implies in addition to your Medicare plan. Therefore, your plans formulary requirements will need to be followed. Click here for more information on the Medicare Extra Help program.

8. Prescription Tourism?

Genvoya may be sold at much cheaper prices outside of the U.S. The reasons for this are numerous and are a topic all to itself.

Technically, possessing prescription medication from foreign sources is illegal. However, if you have a prescription from your doctor for the medication you would not be prosecuted. In fact, some states have proposed legislation allowing state Medicaid patients to travel to foreign contries to obtiain prescription medications.

Contact your insurance, see if they have a program for this. Also, make sure you are obtaining the medication from a reputable institution in the country you travel to, such as a hospital or health system.

Finally, let you doctor and pharmacist know. They may be able to assist with this process.

9. Save Money with Prevention

HIV attacks the immune system, weakening it and making normal infections more severe. Many people with HIV may think that immunizations could be dangerous. However, it is important for HIV patients to get vaccines while there immune system is still strong to prevent additional problems.

Vaccines are covered by most insurances as preventative care, since the passage of the Affordable Care Act. Almost all insurers pay 100% for preventative care.

Therefore you should make sure you get your vaccines up to date and keep track of them. This can save you big in the long run by preventing emergency room or hospital visits.

Vaccines to ask your doctor about:

Influenza, yearly
Pneumococcal vaccine, frequency depends on you age
Meningococal vaccine
Tdap
Hepatitis B
HPV
Varicella
MMR

Final thoughts

Genvoya is a effective, yet very costly medication to treat HIV. Weighing all the options will provide the best outcome for you. Please keep in mind that you always need to use a barrier prevention method for sexual activity even if you take Genvoya to keep from spreading the virus. Personal items that contact body fluids should not be shared, Genvoya does NOT prevent the spread of HIV.

Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!