According to a new analysis of silver-level plans in 31 states as well as the District of Columbia, HIV/AIDS patients face limited coverage of common drug treatments and therefore face high out-of-pocket costs.
Silver plans cover fewer than seven out of the 10 top used medical treatment options or charge over $200 in cost sharing per month, as found by an analysis by consultant group Avalere Health of 2015 silver plans on the insurance marketplace.
A mere 16 percent of silver plans – the most popular in the marketplace – fully cover the top HIV/AIDS drug therapies and charge customers less than $100 in a given month. Insurance covers 70 percent of health care charges while patients shoulder the 30 percent.
Caroline Pearson, Avalere senior vice president and author of the analysis, said that while plans usually follow a unified formula from one state to another, HIV surfaces as the exception. "If you happen to be in a state that covers them well, you're well off," she said.
Pearson is hardly optimistic of the road ahead: she does not expect massive stirs in HIV/AIDS drug coverage in 2016. “[I]t’s likely the same barriers will remain,” she warned, urging consumers to be carefully select their plans.
For the Tampa-based advocacy group, The AIDS Institute, the practice takes place not just in Florida but around the United States. "It's just more ammunition showing that many plans are engaging in discriminatory plan designs," said Carl Schmid, deputy executive director.
In 2014, The AIDS Institute, along with the National Health Law Program filed a suit at the health department’s Office for Civil Rights against four Florida-based insurance companies Cigna, CoventryOne, Humana, and Preferred Medical for violations of anti-discrimination clauses in the health law.
They accused the insurers of structuring their prescription medication plans in a way that discouraged HIV/AIDS patients from applying, particularly through placing all HIV drugs on the top cost-sharing tiers.
Generic drugs were not spared from the practice, added the complainants.
An agreement was eventually reached to make the four companies moved HIV/AIDS drugs into generic tiers and decrease cost sharing this year.
Meanwhile, a recent World Health Organization report declared that tuberculosis has surpassed HIV/AIDS as the deadliest infectious illness in the world, claiming around 1.5 million lives annually.
Tuberculosis is also seen to drive up the cases of diabetes worldwide, a potentially fatal interplay seen 20 years ago between the disease and HIV/AIDS.
From 1990 to 2005, HIV – which weakens one’s immunity and makes him or her prone to the active TB virus – was afflicting some two million individuals in Sub-Saharan Africa, where the number of new tuberculosis cases quadrupled.
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