Sunday, February 1, 2015

ObamaCare/Health Ins. Place High Risk at Risk

The ACA (Affordable Care Act), or ObamaCare, is a complex piece of legislation that was designed to increase access to health insurance. Many high risk groups of American healthcare consumers were unable to access insurance because of pre-existing conditions. These were eliminated by the ACA, and, therefore, access to life-saving medications theoretically would improve greatly. Now, some health insurance plans are beginning to bulk at the price tag to some of these life-saving medications, especially to HIV antiretroviral medications.

These meds are critical to not only many people's physical health but also mental and emotional health. HIV medications only work when taken every single day. If access is limited for even a couple days, a week or more, that medication that had been working to control HIV may no longer work for that patient. This is why access for HIV patients is so critical. Also, while adhering to a successful medication regimen, an HIV-positive individual is far less infectious to others. (, This makes the cost of the medications much more cost-effective than cost-prohibitive.

Having a 30-day/30-pill supply of a medication cost thousands of dollars is extreme to begin with. Yes, R&D for antiretrovirals is expensive, but when you multiply that 30-day supply by 12 months, then by years, then by the number of consumers taking these meds, the costs begin to seem completely out of balance. The top one-a-day HIV combination costs $2,177 a month. (

One of the drivers of these high pricing of HIV meds is that literally NO ONE can afford these meds. This forces the federal government to pick up the tab. Deeper pockets create bigger bills. Without these HIV medications, these Americans will die painful, agonizing and very costly deaths. The benefit of using these medications is increasing the number and quality of years of life.

With the ACA, many HIV consumers are new to the health insurance marketplace and health insurance companies are simultaneously wrestling with decreasing their own costs. It makes sense that health insurance companies are looking to offset an over $2,000 a month cost. However, the 30% co-pay some insurance companies are using to displace this onto consumers is not only unacceptable, it's against the ACA. (

Ultimately, the fix will have to be a combination of strategies, including some form of subsidizing healthcare costs for high risk/high cost consumers coupled with better regulation of prices for these life-saving drugs by pharmaceutical companies. Adapting state ADAP programs to assist HIV consumers navigate and afford these meds will be necessary in the interim.(

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