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CDC HIV/AIDS/Viral Hepatitis/STD/TB Prevention News Update

UNITED STATES: Group Says Plans Discourage HIV Patients


Wall Street Journal (12.10.2013)

The Wall Street Journal reported that a coalition of 31 HIV/AIDS organizations believed some insurance companies were discouraging HIV-infected individuals from enrolling in policies presented in the Affordable Care Act (ACA) marketplace by requiring them to pay thousands of dollars a month for HIV drugs. ACA prohibited insurance companies from discriminating against sick people by charging them more than healthy people or denying sick people coverage. On December 10, the coalition advised US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius that some plans included in the ACA health insurance exchange did not cover all HIV drugs and some companies required HIV-infected people to pay up to 50 percent of drug costs in addition to a separate drug deductible. For example, one company required all Florida patients to contribute 50 percent of HIV drug costs; another required all patients in Florida and other states to pay 40–50 percent of all HIV drug costs; and a third company covered only six HIV drugs and required Florida and Alabama patients to pay 50 percent of HIV drug costs in addition to a separate drug deductible. In contrast, insurers traditionally have required people to pay a flat copay of $10 to $50 for other drugs. According to Kevin Lucia, a research professor at Georgetown University’s Health Policy Institute, guidance from President Barack Obama’s administration would clarify whether such plans discriminated against HIV-infected people. An HHS spokesperson responded that insurance plans included in the ACA marketplace must cover prescription drugs, and HHS was exploring whether the agency would take further action to ensure consumers had access to HIV medicines.


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Information in this article was accurate in December 11, 2013. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.