Advocates are urging patients with HIV/AIDS to delay enrolling in health insurance plans on the exchanges, warning that coverage for them and the price of prescription drugs during the early days of open enrollment will be confusing.
According to a report by InsideHealthPolicy, advocates for HIV/AIDS patients say a “substantial concern” has been raised about how existing AIDS Drug Assistance Programs (ADAPs) can coordinate with the exchanges so that AIDS patients “don’t get saddled with high costs when they need to get necessary medications.”
Though many of the state ADAPs pay premiums and out-of-pocket costs for HIV/AIDS drugs, they will only provide “wrap-around” coverage for plans that cover drugs on the ADAP formulary. The exchange health plans must still undergo “further analysis so that patients can be directed toward the most appropriate plans,” said AIDS Institute Deputy Executive Director Carl Schmid.
The report states that the role ADAPs will play in the state exchanges is “unclear.” However, the AIDS Institute said that patients with HIV/AIDS who are eligible for Medicaid should enroll.
According to HHS’ Health Research and Services Administration (HRSA), in order to use ADAP funds to buy health insurance, the state exchange programs “must confirm that the health plan includes drug benefits equivalent to HIV retroviral and opportunistic infection-related medications on the ADAP formulary, and assess the aggregate cost of paying for the health insurance versus paying for the full cost of medications.”
In addition, the report indicates so-called “Ryan White” funds “can’t be used for any administrative costs, and in general Ryan White is a payor of last resort so patients must try to use other funding sources when possible, Schmid says.”
According to HRSA, “Ryan White funds may only be used to purchase and maintain health insurance that is cost-effective.”