Another day, another condition that health insurers are making difficult to prevent and treat.
It’s almost funny. The very title ‘insurer’ suggests their sole purpose is to ensure patients can access the care they need, but insurers continue to roadblock care that they’re supposed to cover.
The latest example: An April 27th article in Axios highlights alarming access issues for individuals at risk for HIV infections.
Across the country, more than one million individuals have HIV, with approximately 40,000 new cases arising each year, according to Kaiser Health News. Pre-exposure prophylaxis (PrEP) is more than 90% effective in preventing HIV transmission, and the Affordable Care Act requires that necessary doctor’s visits and HIV prevention medications like PrEP are fully covered by insurance plans.
Yet – less than 10% of those who could benefit from PrEP take it. That’s because many insurance plans make coverage of the drug difficult, if not impossible.
“Billing problems that shift costs to patients lead many [patients] who would benefit to opt out.” Some of these billing problems include new prior authorizations, or prescription length changes. As a result, many patients continue to get bills for PrEP, lab work and doctor’s office visits.
Jeffrey Crowley, director of the Infectious Diseases Initiative at the O’Neill Institute and a former director of the White House Office of National AIDS Policy, stated:
“You hear stories all the time…. They’ve been on PrEP and then all of a sudden, there’s a new obstacle…. All of these hassle factors cause people to fall off.”
According to the article, back in August, the feds even gave insurers a 60-day grace period to get into compliance, agreeing not to fine any insurers as they worked out the kinks of the new coverage requirements. Yet here we are—a solid nine months after the guidance was released—and patients are still struggling to get the care they need.
On the health insurer side, many companies are blaming providers for improperly coding the visits as preventative care. An issue that could easily be fixed, they claim. But Katie Keith, a health law expert at Georgetown University, rebuts:
“I am sympathetic to that. But once [insurers] know about that, it should get fixed. And it keeps happening…. I’m much more deeply troubled by, even when you’re telling your plan or your providers to tell your plan that this should be covered, that people are having to jump through such incredible hoops.”
We couldn’t agree more.