Thursday, July 28, 2016

Discriminatory Design: HIV Treatment in the Marketplace

By: Sean Dickson, Senior Manager, Health Systems Integration, National Alliance of State & Territorial AIDS Directors (NASTAD)

The National Alliance of State and Territorial AIDS Directors (NASTAD 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.

Discriminatory Design: HIV Treatment in the Marketplace
States and the Centers for Medicare & Medicaid Services (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
The full report can be downloaded online at

Please contact Sean Dickson with any questions at


Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

1 comment:

Sue Saltmarsh said...

A$ Executive Director of Demand Universal Healthcare (DUH), I'm sorry to see the shameful findings of this report. But I'm also grateful that it was released, as it gives DUH one more fact-based tool to use in our education about and argument for single-payer healthcare. As a former service provider and long-time ally of the HIV/AIDS community, it has always frustrated and disappointed me that the community has not openly advocated for single-payer. Perhaps as more and more of this kind of discrimination takes place (and neither of the major party "choices" will do a thing to decrease it), those living with HIV will join the 53% of Americans and 81% of Democrats who favor a publicly-funded, comprehensive single-payer plan. We will certainly welcome the kind of fierce activism that HIV+ people have shown!