By Mrinal Gokhale
For people who have HIV, living a long healthy life requires regularly taking prescription medicines to prevent the HIV from turning to AIDS. According to Bill Keaton, executive director of AIDS Resource Center of Wisconsin (ARCW), there are 16 HIV medications on the market today. This is why the ARCW, along with the Harvard Law School’s Center for Health Law and Policy (CHLPI) strive to combat discriminatory marketplace insurance plans that make these medicines hard to access.
It was recently announced that the CHLPI not only partnered with ARCW, but with seven other organizations each in Illinois, Pennsylvania, Texas, Atlanta, Louisiana and Texas to identify marketplace health insurance plans that either do not cover or charge high copays or co-insurance for the 16 HIV medications. They have filed a complaint for the eight plans with the Office of Civil Rights, hoping to see these plans cover the medications in the future.
In Wisconsin the Anthem Blue Cross/Blue Shield Silver Plan was the only plan identified as a part of the complaint, according to Keaton.
“This plan does not cover 12 of the 16 medications, making it difficult to create the right HIV regiments for different people and their needs,” Keaton said.
He went on to say that switching health insurance carriers could also mean switching doctors.
“A good doctor-patient relationship is important with HIV, and it’s not good to break that relationship,” Keaton said. “Maybe someone wants this Anthem plan if their doctor is in the plan but cannot enroll if their HIV medicines are not covered.”
By submitting this complaint, he said, the goal is to re-enforce the guidelines of the Affordable Care Act that prevent insurance carriers from denying individuals with pre-existing conditions.
“Insurance companies used to deny those with chronic conditions because it would mean more money out of their pocket, but the Affordable Care Act prevents this practice,” Keaton said.
Within Wisconsin the HIV rates are low compared to some other states, but Milwaukee County has a very high rate. People of color are disproportionately impacted as well.
“Based on a study published by Wisconsin Department of Health Services, people of color make up just 17 percent of Wisconsin’s population, but 63 percent of new diagnoses are from people of color, “ Keaton said. “Furthermore, one in three young black men having sex with men live with HIV.”
Carmel Shachar, a clinical instructor at Harvard CHLPI, said that Wisconsin’s Anthem plan is a national outlier compared to the other states that were a part of the analysis.
“The other plans that were a part of the complaint do cover most of the medicines, but charge high copays or co-insurance,” she said.
Shacar, whose role included drafting the complaint, also helped research many HIV advocacy and healthcare practices in many U.S. cities ever since the Affordable Care Act began.
“In past years, we analyzed about five silver level plans per year, but last year, we expanded that number to 18. We sought the most discriminatory plans against HIV patients,” Shacar said.
These 18 states were chosen due to the fact that Midwestern and southern states have a history of noting organizations are currently waiting for the Office of Civil Rights in Washington, D.C. to reply.
“I hope the complaint is taken seriously because open enrollment for marketplace insurance is in November, and we don’t want the 2017 marketplace plans to be discriminatory towards HIV patients,” Shacar said.