Insurer adds HIV treatments after discrimination complaints

Medica Improves Formularies in Iowa and Minnesota

Washington DC… In response to discrimination complaints filed by the HIV+Hepatitis Policy Institute, Medica, a Minneapolis-based health insurer covering 1.4 million people, has made dramatic improvements in the coverage of medications for the treatment of HIV in its 2026 ACA Marketplace formularies.

In November 2024, HIV+Hep filed discrimination complaints with the states of Iowa and Minnesota contending that Medica’s formularies unlawfully deterred enrollment for people living with HIV by not covering recommended treatment regimens and placing most antiretrovirals on the highest cost tier.

“We are pleased to see the improvements in Medica’s coverage of HIV drugs,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “While it took a year, with two letters and a great deal of research, we are grateful to the Iowa insurance department for working with Medica on these changes. Though we never received a formal response from the Minnesota insurance department, we assume our complaint played a major role in that state as well.”

“Despite the substantial improvements in Medica’s formularies, the issuer still offers substandard coverage and remains an outlier when compared to other issuers on the Iowa and Minnesota Marketplaces, as we have detailed in follow-up letters to regulators in both states.” (See Iowa letter and Minnesota letter.)

“These discriminatory benefit designs should never have been offered in the first place, and insurance regulators should not rely on complaints to uncover discrimination in the plans they oversee.  We call on state insurance regulators to examine the remaining issues with Medica coverage and ensure that all state-regulated plans meet ACA requirements for non-discriminatory coverage of HIV treatment.” 

Some of the improvements in Medica’s 2026 formularies include increasing coverage of single tablet regimens (STRs) in Iowa and Minnesota from 3 to 10 (out of 12), increasing coverage of recommended first-line treatment drugs from 3 to 5 (out of 8), and a reduction from 84% to 71% of HIV drugs placed on the highest cost-sharing tier.

However, despite these improvements, Medica continues to engage in discriminatory benefit design that deters people with HIV from enrolling in their plans and remains an outlier among issuers on both state Exchanges.  In comparison, other issuers in Iowa such as Ambetter and Wellmark cover all 8 recommended first-line treatments and all 12 single-tablet regimens while in Minnesota, BCBS and UCare also cover all the STRs and recommended drugs.  In terms of tiering, in Iowa all other issuers place a far lower percentage of HIV drugs on the highest tier: Ambetter (2.3%), Oscar (4.5%), UHC (2.6%), and Wellmark (12%).  In Minnesota, the percentage of HIV drugs on the highest tier are BCBS (2.3%), Health Partners (4.8%), and Quartz (7.3%).  This all demonstrates that Medica remains an outlier and still does not meet ACA nondiscrimination requirements. 

Though we have not submitted formal complaints, we note that Medica continues to offer similar discriminatory and substandard formularies in other states, such as Kansas, Missouri, Nebraska, North Dakota, Oklahoma, and Wisconsin.   

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The HIV+Hepatitis Policy Institute is a national, non-profit organization whose mission is to promote quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.