Discriminatory Design: HIV Treatment in the Marketplace

By Sean Dickson July 18, 2016

Today, NASTAD (National Alliance of State and Territorial AIDS Directors) published a groundbreaking report on the treatment of HIV medications by Affordable Care Act insurance plans available on the Federally-facilitated marketplaces. This report – Discriminatory Design: HIV Treatment in the Marketplace – reveals pervasive deficiencies in marketplace plans’ coverage and pricing of HIV medications. States and CMS are currently reviewing plan designs for 2017, and this report will help guide their review to reduce discriminatory plan design for persons living with HIV. The report highlights the direct relationship between drug prices and insurer restrictions, underscoring the need for comprehensive drug pricing reform in addition to monitoring and enforcement of non-discrimination protections.

Key findings include:

  • 20% of plans only cover one single-tablet regimen, Atripla, the oldest and least-recommended regimen
  • One-third of plans place all covered single-tablet regimens on the specialty tier
  • Over 45% of Bronze plans subject all covered single-tablet regimens to co-insurance
  • 15% of plans do not cover any HIV drugs introduced since 2013
  • 34% of plans place Truvada, which can prevent HIV infection as Pre-Exposure Prophylaxis (PrEP), on the specialty tier
  • 29% of plans require patients to “fail-first” on another HIV drug before taking Stribild, a leading single-tablet regimen
  • Cost-Sharing Reduction plans, intended to help low-income individuals access affordable insurance, have the same high levels of co-insurance as Silver plans
  • Increases in drug list prices lead to increased frequency of co-insurance at statistically significant levels

Please contact Sean Dickson with any questions.