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. 2023 Apr 20;16(1):57.
doi: 10.1186/s40545-023-00559-8.

Access to a novel first-line single-tablet HIV antiretroviral regimen in Affordable Care Act Marketplace plans, 2018-2020

Rohan Khazanchi  1   2   3   4   5 , Samuel Powers  6 , Amy Killelea  7   8 , Andrew Strumpf  6 , Tim Horn  7 , Auntré Hamp  7 , Kathleen A McManus  9
Affiliations

Access to a novel first-line single-tablet HIV antiretroviral regimen in Affordable Care Act Marketplace plans, 2018-2020

Rohan Khazanchi et al. J Pharm Policy Pract. .

Abstract

Background: A pillar of the United States' Ending the HIV Epidemic (EHE) initiative is to rapidly provide antiretroviral therapy (ART) in order to achieve HIV viral suppression. However, insurance benefit design can impede ART access. The primary objective of this study is to understand how Affordable Care Act (ACA) Marketplace qualified health plan (QHP) formularies responded to two new ART single tablet regimens (STRs): dolutegravir/abacavir/lamivudine (DTG/ABC/3TC; approved in 2014) and bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF; approved in 2018).

Methods: We conducted a descriptive study of individual and small group QHPs to assess coverage, cost sharing (coinsurance vs. copay), specialty tiering, prior authorization, and out-of-pocket (OOP) costs for DTG/ABC/3TC and BIC/FTC/TAF. All individual and small group QHPs offered in state ACA Marketplaces from 2018-2020 were identified using plan-level formulary data from Ideon linked to end-of-year data from Robert Wood Johnson Foundation's Individual Market Health Insurance Exchange (HIX).

Results: For 2018, 2019, and 2020, respectively, we identified 19,533, 17,007, and 21,547 QHPs. While DTG/ABC/3TC coverage was above 91% from 2018-2020, BIC/FTC/TAF coverage improved from 60 to 86%. Coverage of BIC/FTC/TAF improved in EHE priority jurisdictions from 73 to 90% driven by increased coverage with coinsurance. Although BIC/FTC/TAF had a higher wholesale acquisition cost than DTG/ABC/3TC, monthly OOP cost trends differed regionally in the Midwest but did not differ by EHE priority jurisdiction status.

Conclusions: QHP coverage of STRs is heterogeneous across the US. While coverage of BIC/FTC/TAF increased over time, many QHPs in EHE priority jurisdictions required coinsurance. Access to new ART regimens may be slowed by delayed QHP coverage and benefit design.

Keywords: Access to care; Coinsurance; Copay; Cost; Coverage; Drug pricing; HIV; Pharmacoequity.

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Conflict of interest statement

Dr. Khazanchi reports receiving grant funding from the Infectious Diseases Society of America and Boston Children’s Hospital, serving as a paid consultant to the New York City Department of Health & Mental Hygiene’s Office of the Chief Medical Officer, and serving on the strategic advisory board of the Rise to Health Coalition. Ms. Killelea reported receiving grants from Gilead Sciences, Inc. Mr. Horn and Mr. Hamp reported that NASTAD receives grant funding from Gilead Sciences Inc. and ViiV Healthcare for organizational support; all funding to NASTAD was separate from this project. Dr. McManus reports previously owning stock in Gilead Sciences, Inc; and receiving grants from the National Institute of Allergy and Infectious Diseases (NIAID). No other relevant disclosures were reported.

Figures

Fig. 1
Fig. 1
Coverage of DTG/ABC/3TC and BIC/FTC/TAF by Region and “Ending the HIV Epidemic” Status, 2020. Coverage of both medications was higher in the Northeast, compared to the Midwest, South and West. Coverage of both medications was lower among QHPs in the West compared to the other regions. A higher proportion of QHPs in EHE jurisdictions covered both medications compared to non-EHE jurisdictions
Fig. 2
Fig. 2
Qualified Health Plan Coverage and Cost Sharing for DTG/ABC/3TC and BIC/FTC/TAF by Region, 2018–2020. Coverage of BIC/FTC/TAF increased in each of the regions, driven by coverage with coinsurance. DTG/ABC/3TC coverage was stable for QHPs in the Midwest, decreased slightly among the South, and increased for Northeast and West states
Fig. 3
Fig. 3
Qualified Health Plan Coverage for DTG/ABC/3TC and BIC/FTC/TAF by “Ending the HIV Epidemic” Status, 2018–2020. Coverage of BIC/FTC/TAF increased in both EHE and non-EHE jurisdictions, driven by coverage with coinsurance
Fig. 4
Fig. 4
Qualified Health Plan Coverage of DTG/ABC/3TC and BIC/FTC/TAF by State, 2018–2020. For each state, the y-axis reflects the proportion of qualified health plans offering coverage for either DTG/ABC/3TC and BIC/FTC/TAF. Coverage of both medications was consistently high in states like MD, DE, SC, and DC. Coverage of BIC/FTC/TAF increased in most states except for MS, ID, SC, and FL. The point values for each state-year are provided in Additional file 1: Table S1
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References

    1. Kaiser family foundation. HIV Viral suppression rate in U.S. lowest among comparable high-income countries. Kaiser family foundation. 2021. https://www.kff.org/hivaids/slide/hiv-viral-suppression-rate-in-u-s-lowe.... Accessed 4 Jan 2021.
    1. McCann NC, Horn TH, Hyle EP, Walensky RP. HIV antiretroviral therapy costs in the United States, 2012–2018. JAMA Intern Med. 2020;180(4):601–603. doi: 10.1001/jamainternmed.2019.7108. - DOI - PMC - PubMed
    1. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–845. doi: 10.1001/jama.2019.1343. - DOI - PubMed
    1. Office of Infectious Disease and HIV/AIDS Policy, U.S. Department of Health & Human Services. Priority Jurisdictions: Phase I. HIV.gov. 2020. https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/jurisdictio.... Accessed 14 Feb 2021.
    1. Zamani-Hank Y. The affordable care act and the burden of high cost sharing and utilization management restrictions on access to HIV medications for people living with HIV/AIDS. Popul Health Manag. 2015;19(4):272–278. doi: 10.1089/pop.2015.0076. - DOI - PubMed