Latest study suggests that the high price tag of HIV drugs makes it difficult for patients and many health insurers put these drugs in the highest cost-sharing group.
The 2010 Affordable Care Act (ACA) banned any discrimination that was based on any pre-existing medical conditions. Per ACA, insurers should not ask about past or current conditions, charge people more if they have any medical condition such as cancer, diabetes and more, or deny insurance coverage. However, some insurers are still believed to be discriminating in the case of HIV patients.
Douglas Jacobs, who is pursuing degrees in public health at the Harvard T. H. Chan School of Public Health and medicine at the University of California, San Francisco, and also the lead author of the study, suggests that some insurers are dissuading HIV patients from enrolling due to high-cost HIV drugs.
Usually, insurers get a person to complete a set of forms, provide a list of covered drugs and out of pocket costs for steering patients to medicines or generic drugs for which an insurer has already negotiated a favorable cost. Ben Sommers, the co-author of the study, suggests that forms can be designed in a way that discourages people with pre-existing medical conditions.
The study analyzed 48 Obamacare, or ACA, policies across 12 states in the country with the help of the federal Healthcare.gov marketplace. The study found that in 2014, 12 policies placed all HIV drugs covered under the policy, which required consumers to pay at least 30 percent of the cost. Some insurers did not cover the HIV drugs.
People in these plans had to pay three times the average cost per HIV drug in comparison to customers in other plans.
"The ACA has made a major positive change for people with preexisting conditions--they can now purchase insurance without paying higher premiums or getting denied coverage." says Jacobs. "But some insurance companies seem to be setting up formularies that continue to discriminate against people with chronic conditions."
The study also calls for policymakers to take appropriate steps to stop such discrimination.
The U.S. Centers for Disease Control and Prevention (CDC) suggests that more than 1.2 million Americans are living with HIV in the U.S. and more than 50,000 new HIV cases are reported each year. The high price tag of the HIV drugs will make it very difficult for patients to be treated, which many result in their medical health to deteriorate and result in more complications.
The study has been published in the New England Journal of Medicine.