Patient Access to HIV Drugs in Exchange Plans is Limited Compared to Other Sources of Coverage

Avalere Health has published a new analysis on coverage of HIV medication in Qualified Health Plans (QHPs). The analysis examined 1,494 Affordable Care Act Silver QHPs and found that only 16% of these plans in 2015 cover all top HIV drug regimens with cost sharing less than $100 per month per regimen. While almost half of plans include all ten of the most commonly use HIV regimens on their formularies, many plans charge higher out-of-pocket costs for these drugs. Read the full report..

The Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School released commentary about this new analysis from Avalere. CHLPI has monitored trends in state Marketplaces for the past two years of open enrollments and is seeing lower rates of coverage of necessary HIV treatment regimens concurrent with increased cost sharing for those regimes that are covered. Read the CHLPI commentary.

About Alyssa Kitlas

Alyssa Kitlas serves as a Program Analyst on NACCHO's HIV, STI, and Viral Hepatitis team. Her work includes projects on HIV, STI, and Viral Hepatitis prevention and care. Twitter: @AlyssaKitlas

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