News & Press

Letter Writing Campaign ~~ Important HIV medications absent from drug formularies

From our friends at HIV Health Reform, and written by Priti Bhattarai

Inadequate Marketplace Coverage Raises Concern among HIV Advocates

With the health insurance marketplace now open for enrollment, it is essential that all health plans offer adequate coverage and have transparent policies. However, preliminary findings show there is a critical need for easier access to qualified health plan data, and important HIV medications seem to be absent from drug formularies. Both issues demand immediate attention to better facilitate enrollment of people with HIV/AIDS into the Marketplace plans.

Based on a preliminary review conducted by the HIV Health Care Access Working Group (HHCAWG), a coalition of national HIV health policy advocates, several marketplace plan formularies seem to be missing one or more Single Tablet Regimens (STRs) and/or do not provide clear information on drug coverage.

The success of the ACA for people with HIV/AIDS will be determined by whether they have access to the latest treatment advances, one of which is the availability of combination antiretroviral medications, or single tablet regimens. STRs play a vital role in the management of HIV disease, as they significantly reduce daily pill burden, increase adherence and improve health outcomes.

According to HHCAWG, 23 insurance plans exclude STRs in several states, which is inconsistent with the current standard of care for HIV. A majority of public and private health insurance plans cover STRs, including the state benchmark plans that set the minimum standard for pharmaceutical coverage under the Affordable Care Act (ACA). It also appears that accurate information on antiretroviral coverage and in-network HIV providers, which is critical to selecting an appropriate insurance plan, is currently extremely difficult to obtain.

The steering committee of HHCAWG has written letters to express their concern to Secretary Kathleen Sebelius, Department of Health and Human Services (HHS) and Gary Cohen, the Director of Center for Consumer Information and Insurance Oversight (CCIIO). HHCAWG wrote to those insurance companies who have yet to provide appropriate coverage for STRs in Marketplace drug formularies.

The letters highlight the list of plans that exclude STRs in several states, the need to amend formularies to include all STRs allowing people with HIV access to these medications, the need to update plan profiles in marketplace, and the implications of failing to cover STRs, which may result in dangerous disruptions in treatment.

ACA allows many tens of thousands of individuals with HIV to have access to health insurance coverage. However, limiting access to STRs won’t allow HIV patients enrolled in plans to access the simplified drug regimens that promote treatment adherence, putting them at greater risk for developing more serious and costly complications.

Take Action!
Read the sample letter to the insurance companies and advocate for a better coverage by writing to the insurers at your state demanding for better access to care!

HIV Health Care Access group ARV Letter (PDF)
Letter to Center for Consumer Information and Insurance Oversight (PDF)
Letter to Department of Health and Human Services (PDF)
Sample Letter to insurance company (template)

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Posted on November 14, 2013 at 11:41 am