By Consumers For Quality Care, on March 9, 2022
Over a year since the federal government mandated insurance companies cover an HIV prevention drug at no cost, consumers are still being charged hundreds or even thousands of dollars for this life-saving medicine, according to Kaiser Health News.
In June 2019, a national panel of health experts concluded that HIV prevention drugs are a critical weapon in quelling the AIDS epidemic. Under provisions of the Affordable Care Act, the decision to rate pre-exposure prophylaxis, or PrEP, as an effective preventive service triggered rules requiring health insurers to cover the costs. Insurers were given until January 2021 to adhere to the ruling.
Despite the law, patients are now confounded by formularies that obfuscate drug costs and by erroneous bills for ancillary medical services. “Insurers are quite smart, and they have a lot of staff,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. They are setting up “formularies in a way that looks like I’m going to have to pay, and that’s one of the barriers. They are not showing this is free for people in an easy way.”
Although enforcing coverage rules falls to state insurance commissioners and the Department of Labor, enforcement is driven largely by patient complaints. Previously, CQC highlighted a story where a Washington, D.C. consumer was wrongfully charged for his PrEP medication. The consumer was ultimately refunded all his copays after making inquiries.
Insurers must continually ensure consumers are not receiving – and paying – unnecessary bills. Consumers should also be aware of their patients’ rights when it comes to preventive care.