Today, 1.1 million Americans live with HIV. Many people seeking HIV treatment are discovering that some policies offered through the Affordable Care Act’s insurance exchanges come with high out-of-pocket costs and few affordable treatment options.
A recent Avalere Health study found that between 25 and 35 of the most popular plans classify HIV/AIDS medications as top tier drugs — resulting in top tier costs. Rather than a co-pay — or a set fee charged per prescription — HIV drugs are subject to co-insurance fees, which makes patients responsible for a percentage of a medication’s cost. As a result, many HIV patients need to directly pay for 40 percent or more of their treatment costs.
Congress must intervene, cracking down on those insurers whose coverage discriminates against vulnerable Americans in need of specialty medication.
Co-insurance would financially devastate most people who rely on specialty medicines. But it’s especially challenging for those with HIV. A recent study by the Centers for Disease Control and Prevention found that 1 in 42 urban dwellers living below the federal poverty line had HIV, compared to the national infection rate of 1 in 222.
With the average annual cost of antiretroviral HIV care around $20,000, a growing number of patients are being forced to choose between food and medicine.
Indeed, a recent study from my organization, HealthHIV, found that 48 percent of people living with HIV say cost is their biggest barrier to health care. We have heard from constituents who have rationed or discontinued their treatment altogether in an effort to support their families. Some of our constituents have stopped treatment entirely because of coinsurance fees.
Congress must address this problem head-on. The public health consequences of high co-insurance costs will only worsen.
Without treatment, people living with HIV are more likely to visit the emergency room, spend more time in the hospital (resulting in higher health care costs for everyone) and are more likely to transmit the virus to others.
Already, 125,000 people die each year because of non-adherence to prescription regimens for HIV/AIDS and other chronic conditions. Together, these patients account for 1 in 10 of all hospitalizations that occur every year, which add more than $100 billion in costs to the health care system.
The Patient Protection and Affordable Care Act was established to make sure all Americans — especially vulnerable populations — could readily access the medical care and treatment they need. Yet many of the health plans in the exchanges have priced life-saving HIV drugs out of reach. Congress must put a stop to this short-sighted and morally bankrupt practice, and keep ‘patient protection’ in health reform.
Brian Hujdich is the executive director of HealthHIV, a national HIV non-profit organization.