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What good are medical advances if insurance won’t pay for them?

Advocates say Blue Cross Blue Shield of North Carolina jeopardizes HIV patients’ access to critical life-saving medications.

We’ve come a long way in modern medicine, especially when it comes to HIV care. In the mid-90s, life expectancy at age 20 for HIV-infected individuals was just 39 years old. Today, research shows people with HIV can live just as long as those without the virus.

This is, in part, due to the amazing developments in treatment. It wasn’t until March 1987 that an antiretroviral drug called zidovudine, commonly known as AZT, became the first treatment for HIV. And many more have followed.

But there’s a catch to all that good news. To have a life expectancy on par with those not infected with HIV, access to effective HIV treatment as soon as possible is essential. And therein lies the issue.

Because even though we’ve come a long way in HIV medical care, what’s the good of these treatments if insurance companies won’t pay for them?

That’s the question coming out of North Carolina, as Blue Cross Blue Shield of North Carolina (BCBSNC) – North Carolina’s largest insurer – placed almost all HIV medicines in its most expensive drug categories. This is especially concerning given that more than 35,000 North Carolinians live with HIV, according to the North Carolina Department of Health and Human Services.

The North Carolina AIDS Action Network and the HIV+Hepatitis Policy Institute, two HIV advocacy organizations for the state, are raising a flag on what they call ‘discriminatory’ plans from BCBSNC. Both advocacy groups filed official complaints with the NC Department of Insurance and the Office of Civil Rights at the federal Department of Health and Human Services back in December.

In addition to placing nearly all HIV medications in the most expensive drug tiers, “the few medication options offered at a lower cost cannot be used on their own or are older drugs that are no longer recommended,” reports NC Health News. In other words, what’s the point in covering them at all, BCBSNC?

The result? Exorbitant out-of-pocket costs for drugs that treat HIV, limiting thousands of patients’ access to life-saving treatment.

This is not the first time the Un-covered team has covered access issues in HIV care. Insurance companies have been using tactics such as new prior authorizations, prescription length changes, and other billing problems to make it harder for patients to access PrEP, a drug that is more than 90% effective in preventing HIV transmission. Antiretroviral medications can help to slow damage caused by HIV infection and prevent it from developing into stage 3 HIV, or AIDS. These are groundbreaking advancements.

But what good is any of it if you’re prevented by insurance companies — which are supposed to actually provide insurance for medical conditions — refuse to cover care, or place unfairly high out-of-pocket costs? We, and likely the 35,000 North Carolinians living with HIV, would like to know.

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