HIV Treatment and the Affordable Care Act

Click here to view the 2016 Plan Analysis for Qualified Health Plans: Pennsylvania
Click here to view the 2016 Plan Analysis for Qualified Health Plans: Pennsylvania

In anticipation of the roll-out of the 2016 Marketplace Plans, the Center for Health Law and Policy Innovation (CHLPI) of Harvard School of Law conducted a multi-state review of the HIV and Hepatitis C related benefits of select plans.

CHLPI assigned AIDS Law Project staff attorney Jacob M. Eden, administrative assistant Messapotamia Lefae, and legal intern Andrew Newstein to review of health plans offered throughout the Commonwealth of Pennsylvania. They were asked to review health care plans in the Silver category offered by a variety of health insurance companies to develop a ‘tool’ or a chart to help people living with HIV or their care providers determine how well each health plan can support their HIV treatment. Specifically, they reviewed cost-sharing requirements (deductibles, co-payments, and co-insurance) for health care services like primary care appointments, blood work or x-rays, or emergency room visits. They also reviewed each health insurance company’s formularies, or the lists of drugs that the insurance company will cover.

After reviewing our findings, CHLPI said that the majority of health plans in Pennsylvania have “generally affordable cost-sharing requirements for HIV treatment.” Most Pennsylvania Silver Plan formularies cover more than 18 of the surveyed HIV drugs. HIV drugs are often placed in a Specialty Tier or the tier on the formulary with the highest cost-sharing requirements. Cost-sharing requirements for HIV drugs varied from plan to plan. Overall, HIV drugs require $40 to $75 copayments and/or require 50% coinsurance after a deductible. Even though they’re supposed to be the most cost-effective plans for low to middle-income consumers, people living with HIV/AIDS may be unable to realize the promises of the Affordable Care Act (ACA). CHLPI is prepared to launch a litigation initiative, based in part on the newly created private right of action found under the anti-discrimination regulations of the ACA. To learn more about CHLPI’s litigation initiative, please contact Kevin Costello at

Click here to see the full “2016 Plan Analysis for Qualified Health Plans: Pennsylvania.”
For more information or to view Silver QHP Analyses for the other states*, go to the Center for Health Law & Policy Innovation’s website.

*Alabama, Georgia, Illinois, Minnesota, North Carolina, Ohio, Oregon, Texas – more to come