US health insurers discriminate with high ARV prices

30 January 2015
An HIV ribbon

A study that looked at health insurance plans under the new Affordable Care Act (ACA) in the United States has found that people living with HIV (PLHIV) on some plans are paying on average $3000 more than PLHIV on other plans. The findings have sparked concerns that these insurance providers are pricing antiretroviral drugs (ARVs) in the highest bracket within their plans – in what has been called ‘adverse tiering’ – to discourage PLHIV taking up policies.

The researchers found that 25 percent of the reviewed insurance providers had discriminatory practices in place towards people living with HIV. In these companies, ARVs were placed on the highest tier of drug pricing – regardless of whether the drugs were generic, and therefore cheaper, or not. They concluded that policymakers should be aware of ‘adverse tiering’, as it will mean that people with pre-existing conditions will most likely take out policies in the few companies that offer more generous plans. This burden may affect these health plan provider’s profits, meaning they may take steps to be more limiting in what they offer people with pre-existing conditions in the future.

Under President Obama’s ACA, discrimination of people with pre-existing conditions is being positively addressed. People are now able to access health insurance without extortionate premiums, or being denied insurance all together. However a researcher from the Harvard School of Public Health, where this study was undertaken, stated: "the use of formularies to increase costs and dissuade those with pre-existing conditions such as HIV from enrolling in the plan threatens to at least partially undermine this goal of the ACA."

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