Helping Patients Navigate the Cost of Isentress

As a provider prescribing Isentress (Raltegravir), you've likely had patients express concern about the cost of their HIV medication. With brand-name Isentress running $1,900 to $2,500 per month without insurance, affordability is a real barrier to adherence — and adherence is everything in HIV treatment.

This guide consolidates the savings programs, discount options, and conversation strategies you can use to help patients stay on Isentress without financial hardship.

What Patients Are Actually Paying

Understanding the cost landscape helps you guide patients more effectively:

• Cash price (uninsured): $1,900–$2,500/month for a 30-day supply of brand-name Isentress
• Commercial insurance: Isentress is typically covered but often placed on a specialty or non-preferred brand tier, resulting in higher copays or coinsurance. Prior authorization is frequently required.
• Medicare Part D: Covered on most formularies. As of 2025, Medicare Part D has a $2,000 annual out-of-pocket cap, which is meaningful for patients on expensive HIV regimens.
• Medicaid: Generally covered, though formulary placement and prior authorization requirements vary by state.
• Ryan White/ADAP: The Ryan White HIV/AIDS Program and AIDS Drug Assistance Programs (ADAP) provide coverage for qualifying patients, often covering the full cost of antiretroviral medications.

Many patients don't know what assistance is available to them. A brief conversation during the prescribing visit can make a significant difference.

Manufacturer Savings Programs

Merck Copay Savings Card

Merck offers a copay savings card for commercially insured patients taking Isentress, Isentress HD, Pifeltro, or Delstrigo:

• Maximum savings: Up to $6,800 per year
• Eligibility: Commercially insured patients only
• Not valid for: Medicare, Medicaid, Tricare, or other government-insured patients
• Patients can enroll online or through your office

This is often the single most impactful resource for commercially insured patients facing high copays or coinsurance.

Merck Patient Assistance Program (PAP)

For uninsured or underinsured patients who cannot afford their medication:

• Program: Merck Patient Assistance Program at merckhelps.com
• Benefit: Provides Isentress free of charge to eligible patients
• Eligibility: Based on income and insurance status
• Application: Requires provider involvement — you'll need to submit documentation confirming the prescription and the patient's eligibility

The Merck SUPPORT Program also assists patients in navigating coverage options and locating payment sources. This can be particularly helpful for patients transitioning between insurance plans or those newly diagnosed.

Coupon and Discount Cards

For patients who don't qualify for manufacturer programs or need additional savings, third-party discount cards can help reduce out-of-pocket costs:

• GoodRx — Compares pricing across pharmacies and provides discount coupons
• SingleCare — Free prescription discount card accepted at most major pharmacies
• RxSaver — Price comparison tool with downloadable coupons
• BuzzRx — Free discount card with savings at participating pharmacies

While these tools are more commonly used for generic medications and may offer limited discounts on specialty HIV drugs, they're worth checking — especially as generic Raltegravir becomes more widely available.

For a comprehensive list of savings resources, you can direct patients to our patient savings guide for Isentress.

Generic Alternatives

The generic landscape for Raltegravir is evolving:

• Lupin's generic Raltegravir received FDA approval in May 2025
• Market availability may still be limited or pending as of early 2026
• Once widely available, generic Raltegravir should significantly reduce costs for patients

Keep an eye on generic availability and consider discussing the option with patients at follow-up visits. For patients who are stable on Isentress and primarily concerned about cost, a switch to generic Raltegravir (when available) could be the simplest solution.

Therapeutic Alternatives

If cost remains prohibitive and the patient is clinically appropriate for a switch, consider other INSTIs that may have different cost profiles or savings programs:

• Dolutegravir (Tivicay) — Has its own manufacturer savings programs through ViiV Healthcare; generic Dolutegravir is also emerging
• Bictegravir (in Biktarvy) — Single-tablet regimen with Gilead's copay assistance programs
• Cabotegravir (Vocabria/Cabenuva) — Long-acting injectable option that may be covered differently by some plans

See our overview of alternatives to Isentress for clinical details on switching options.

Building Cost Conversations into Your Workflow

Many patients won't bring up cost concerns on their own — they may feel embarrassed, or they may simply not fill their prescription and become non-adherent without telling you. Here are strategies for making cost a routine part of your clinical workflow:

At the Prescribing Visit

• Ask directly: "Do you have any concerns about affording this medication?"
• Provide information about the Merck copay savings card and PAP before the patient leaves
• If your clinic has a social worker or patient navigator, make a warm handoff for benefits assistance

At Follow-Up Visits

• Ask about adherence — and if they've missed doses, ask whether cost was a factor
• Review insurance changes (especially at the start of each year)
• Check whether generic Raltegravir has become available and whether it's appropriate for the patient

For Your Staff

• Train front-office and pharmacy liaison staff on the most common assistance programs
• Keep printed or digital resources about Merck's programs readily accessible
• Consider posting information about Medfinder for Providers as a resource for locating medication availability

Leveraging Ryan White and ADAP

If your practice serves patients eligible for Ryan White or ADAP, ensure:

• Eligibility is assessed and enrollment is up to date
• Staff understand the recertification process
• Patients know ADAP can cover their antiretroviral medications

These programs are the most robust safety net for HIV medication access in the United States and should be the first recommendation for qualifying patients.

Final Thoughts

Cost should never be the reason a patient stops taking their HIV medication. With manufacturer programs, discount tools, emerging generic options, and government assistance programs, there are real pathways to making Isentress affordable for virtually every patient.

The provider's role is critical: by proactively addressing cost, connecting patients with resources, and monitoring adherence, you can help ensure that financial barriers don't undermine clinical outcomes.

For help locating Isentress availability for your patients, visit Medfinder for Providers.