Obamacare enrollees are likely to pay more for their HIV drugs compared to those using private insurance, according to a new analysis.
The analysis released Wednesday from the research firm Avalere Health found that only 16 percent of Obamacare’s silver plans this year cover all top HIV drug regimens and charge less than $100 per month per regimen.
Almost half of the silver plans include all 10 of the most commonly used HIV regimens, but many plans charge higher out-of-pocket costs for them, Avalere said.
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The finding means that enrollees in the silver plan, the second tier of three plans offered on the exchanges, have to pay more out of pocket. That is critical because patients facing high costs tend to forego taking their medication over time, Avalere said.
HIV coverage in plans often varies significantly from state to state.
For instance, consumers in 31 states and the District of Columbia find a majority of plans cover fewer than seven of the top HIV regimens and/or require cost-sharing over $200 per month, Avalere said.
A majority of plans in five states — Oklahoma, Alabama, Connecticut, Massachusetts and Rhode Island — have access to all of the regimens and offer them at $100 or less per month.
A majority of Americans still get their health insurance from their job, and those employer plans offer more choice.
HIV drugs are widely covered “on generic and preferred brand tiers and are almost never placed on a specialty tier,” Avalere said.
Prior analyses found that employer-sponsored plans placed HIV drugs on the most expensive tier just 3 percent of the time. That is compared to 30 percent of silver plans that placed all 10 HIV treatment regimens in the highest tier.
