On November 11, Marketplace reported on a new study from Avalere examining patient access to HIV medications in the 2015 Silver Qualified Health Plans (QHPs) of the Affordable Care Act. This study draws attention to major issues around coverage and cost of HIV medications in these plans and reinforces findings by Harvard Law School’s Center for Health Law and Policy Innovation (CHLPI), which has worked on health care reform implementation and monitored trends in state Marketplaces for the past two years of open enrollment.
CHLPI’s director Robert Greenwald spoke with the senior reporter for Marketplace’s Health Desk, Dan Gorenstein, about CHLPI’s work and the implication’s of Avalere’s study.
Excerpt from article:
“Perhaps the clearest example, said Harvard’s Robert Greenwald, is how insurers are switching consumers from a flat copay fee to co-insurance, where a person pays a percentage of their medication.
‘The insurers are saying, “Oh, we can’t keep people off, we can’t charge people higher premiums. I’ve got it. Let’s change the way we do co-insurance,”‘ he said.
For example, Greenwald said some consumers went from a once-a-month $50 copay to a once-a-month $600 co-insurance payment for the same prescription drug. And while consumers benefit from out-of-pocket limits, he said consumers must come up with more cash up front.
Greenwald considers these practices a violation of new civil rights protections under the ACA.”
Read the full article, “Researchers: Insurers are steering some patients away” online.
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May 18, 2023