Summary
Summary: Concern is growing in the United States regarding the potential for health insurance benefit designs to discriminate against people living with HIV (PLHIV) as research demonstrates that such practices are occurring. Authors study Assembly Bill 339, legislation passed in California in 2015 and going into effect on Jan. 1, 2017, which provides protection for PLHIV by requiring coverage for single-tablet regimens (STRs) to manage HIV while placing a cap on patient cost-sharing. Given California's size and influence, and the uncertainty of the future of the Affordable Care Act, this legislation has the potential to influence the national policy debate.
Findings: Adverse tiering for HIV drugs was not a significant issue in California. However, non-comprehensive coverage of STRs appeared to be the larger issue that would impact PLHIV. Further analysis is needed to understand how the AIDS Drug Assistance Program (ADAP) may facilitate access to other STRs if low-income PLHIV require a certain formulation. In addition, an analysis of consumer complaints filed with individual health plans or the California Department of Managed Health Care could reveal the extent to which Californians are filing appeals mechanisms to facilitate access to other STRs.
Despite these limitations, given the size and scope of California and the size of its impacted HIV patient population, this approach will influence other states as they grapple with similar policy options to reduce the financial burden faced by PLHIV and other chronic conditions. The requirement to both cover STRs and to limit prescription cost-sharing will protect insured PLHIV from the financial burden faced by other chronic disease patients whose needed medications may not be covered by their health insurance or covered at an unaffordable price.
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