Patients in ACA exchange plans have limited access to HIV drugs

Patients who are covered through Affordable Care Act exchange plans have more limited access to HIV drugs than those with other types of insurance, according to a new report from Avalere. Only 16 percent of silver-level exchange plans cover all of the top HIV drug regimens with cost-sharing of less than $100 per month, and though nearly half of exchange plans cover all 10 of the most commonly used regimens, many charge higher out-of-pocket costs for the drugs.

In addition, 30 percent of silver plans placed all 10 regimens on their highest tier, while employer plans placed single-source HIV medications on the specialty tier only 3 percent of the time, according to the report.

"Ensuring individuals living with HIV have affordable access to their medications is critical both for maintaining the health of the patient but also for improving public health by limiting disease transmission," Caroline Pearson, senior vice president at Avalere, said in the analysis. Report

Suggested Articles

COVID-19 has dramatically accelerated the adoption of digital health, and a new analysis from Deloitte finds that trend extends similarly to MA.

Centene Corporation earned $568 million in profit in the third quarter, a huge boost compared to its third-quarter 2019 earnings of $95 million.

The massive financial fallout from the COVID-19 pandemic is a "clarion call" for healthcare providers to shift to new payment models, one CEO said.