People with HIV can’t be denied coverage, but can they afford their meds?
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Suellen Kehler of Philadelphia holds some of the more than 20 medications and supplements she takes each day to keep her HIV infection under control. (Emma Lee/for NewsWorks, file)
Insurance companies have always been in the business to make money. Before the Affordable Care Act, one way they did this was to refuse coverage to the sick.
The new health care law prohibits that and bars them from charging higher premiums to people with pre-existing conditions. However, researchers are finding the industry has identified a workaround.
One way some insurers are keeping the sick away is to charge them more for needed drugs, said Harvard’s Doug Jacobs, lead author of a study in the New England Journal of Medicine.
“This appears to be a little bit more of a sneaky way of doing the same thing that insurers have historically done,” he said.
Jacobs says some insurance companies have designed marketplace plans that leave people with HIV on the hook to pay for a larger share of their essential medications — on average, about $3,000 dollars more. The strategy, he says, is to scare away people with chronic conditions, like HIV, from seeking coverage with those companies.
“What we could begin to see if this practice is left unchecked is a race to the bottom in drug plan design,” said Jacobs.
His finding echoes a formal complaint filed last spring against insurers in Florida.
“I think the larger lesson is we really need to be vigilant in overseeing health insurance companies for practices that would discriminate against patients,” he said.
The group, Health Federation of Philadelphia, reviewed HIV drug benefits of marketplace plans in this region (see below).
Aetna’s most common policies push more drug costs on to HIV patients, with all HIV drugs listed in the higher co-insurance categories.
In a statement, the company said its goal is to help members remain healthy, and they’re reviewing their plan designs for next year.
Consumers can check the drug benefit details of marketplace plans on healthcare.gov.
The federal government is reviewing new regulations that would ban such practices in the future.
(Local providers note if HIV drugs are too expensive, individuals with incomes up to 500 percent of the federal poverty level can apply for financial help through Pennsylvania’s HIV drug assistance program.)
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