Health exchange plans limit patient access to HIV drugs: study

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Over the last two years, patient advocates have complained that many insurers are trying to discourage HIV patients from enrolling in health insurance policies created by the company. Affordable Care Act. Now, a new analysis provides new evidence that their concerns are justified.

Only 16 percent of so-called money-exchange plans in 2015 cover the 10 most widely used HIV treatment regimens. These also cost less than $ 100 per month per plan, according to Avalere Health, a consulting firm that conducted the analysis. There are four types of trading plans ranked among the most expensive and least expensive – Bronze, Silver, Gold and Platinum.

But nearly half of the money plans, or 46 percent, include all 10 commonly used diagrams in their forms, which are lists of drugs that benefit from a blanket of benefits. privileged insurance. This means that a drug usually costs less to patients. But many money plans charge higher costs for HIV drugs, according to analysis .

The results are noteworthy because the vast majority of people who are in health insurance exchanges – 68 percent – are enrolled in cash plans. That's about 6.7 million people, according to Caroline Pearson, senior vice president of Avalere.

In addition, HIV medications accounted for 9% of drug spending on exchange health plans last year, according to a report from Prime Therapeutics, a manager. pharmaceutical benefits. More has been spent on drugs to combat diabetes and hepatitis.

"There are persistent barriers to access to anti-HIV drugs in the currency markets," Pearson said. "The plans [the health] clearly show that HIV-infected patients can be expensive to cover and that they do not want to structure benefits to attract a disproportionate proportion of people infected with HIV."

We should note that the analysis was funded by Gilead Sciences, which manufactures most of the drugs used in HIV treatment regimens.

Pearson added that the requirements for coverage and cost sharing of money plans differ from the insurance provided by employers. In general, employer-sponsored insurance does not place HIV drugs in the so-called specialty categories that force consumers to pay higher rates – typically 40% to 50% of costs.

We have asked for feedback from the US health insurance plans, the trade group, and we will keep you informed accordingly. [SETTLEMENT: An AHIP spokesperson sent us this: "The report completely ignores the prices or costs associated with these treatments and the fact that health plans cover the vast majority costs." the plans are "comprehensive" by covering widely used treatment regimens and that the analysis only reflects the plans of 2015. ]

Nevertheless, the findings do not surprise Carl Schmid, deputy executive director of the AIDS Institute, a patient advocacy group that urged federal authorities to investigate discrimination issues against HIV patients in drug plans. ;exchange.

"This is further evidence that the problem exists throughout the country," he said. "And that gives us more ammunition to push for change." The AIDS Institute led a coalition of 197 groups that this week urged Secretary of Health and Human Services, Sylvia Burwell, to address discriminatory conceptions of insurance benefits in a rule that implements the Affordable Care Act,

Last year, his group and another, the National Health Law Program, filed a lawsuit for charging four insurers for illegally discriminating against people living with HIV and AIDS in Canada. their Florida health plans. The groups accused insurers of placing all HIV medications, including generic drugs, on specialty levels.

Since then, Aetna has agreed to reduce costs nationwide, while Cigna, Humana and Preferred Medical have agreed to do so in Florida. And the Florida Office of Insurance Regulation warned insurers not to overload patients for next year.

Meanwhile, the Centers for Medicare & Medicaid Services, which oversees Obamacare, earlier this year responded to concerns by saying that it would review potentially discriminatory practices for drugs in the United States. Exchange plans for 2016. Plans that place expensive drugs in high co-pay or co-pay levels may be asked to justify their policies.

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