Tens of thousands of people most vulnerable to contracting HIV are forced to pay for medication to prevent the virus, despite federal requirements guaranteeing free access to treatment that is critical to ending the HIV/AIDS epidemic in the United States, according to multiple studies and interviews with medical professionals, activists and patients.
Despite the mandate, patients still face bills or prior authorizations, which means that approval must be obtained from their insurance company before starting the medication; otherwise, the medication will not be covered. Up to a third of commercially insured PrEP users paid out-of-pocket for lab testing even after the 2021 mandate. The recourse for patients facing charges when these preventive services should be free is limited. They can either try to push back on their health plan, rely on their provider to do so, or submit a complaint to agencies like their state’s Office of Attorney General or the Division of Insurance. “It is out of control,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, tells Uncloseted Media/Fierce Healthcare. “We need enforcement.”
“Because of years of research and scientific advancements, we now have the tools to prevent and treat HIV and keep people living healthy and long lives,” Carl Schmid, executive director of HIV+Hepatitis Policy Institute, said in a Tuesday statement on World AIDS Day, which is Dec. 1. “Now is not the time to retreat on our commitment to protecting the health of our nation. President Trump initiated the Ending the HIV Epidemic initiative in his first term, which was sustained by President Biden and his administration. Now we look forward to that same commitment from President Trump as he and his new administration seek to make our country healthier, bolster prevention, and address chronic diseases.”
Earlier this month, Philip Chan and Amy Nunn co-signed a letter sent by the HIV+Hepatitis Policy Institute to Rhode Island’s Health Insurance Commissioner Cory King. The letter calls Harvard Pilgrim’s decision to curtail coverage of HIV medications “discriminatory.” It argues that Harvard Pilgrim’s proposed plans do no meet regulatory standards–both state and federal–by failing to provide essential health benefits. The letter also urges the Office of the Health Insurance Commissioner to bring Harvard Pilgrim “in line with HIV treatment guidelines.”
The HIV + Hepatitis Policy Institute filed five discrimination complaints to state insurance commissioners against Medica and Harvard Pilgrim. The organization claims the insurers try to ensure enrollment remains low among people with HIV, and that the insurers place HIV brand-name and generic drugs on the highest cost formulary tier. It is also alleged the plans do not cover drugs recommended by national guidelines, and the insurers don’t meet health benefits benchmarks.