The True Cost of Discriminatory Hepatitis B Drug Tiering
Hepatitis B virus (HBV) is the world’s leading cause of liver cancer and is associated with complicated co-infections- HIV/AIDS, hepatitis C, and hepatitis Delta. An estimated 2.4 million individuals in the US and 50,0000 individuals in Pennsylvania are living with chronic HBV. With no cure, those infected often rely on antiviral medications to control the virus. First-line treatments involve daily antivirals to suppress the virus and must be taken for several years. Barriers to access, including high costs, can cause patients to forgo needed treatment, stop treatment prematurely, or seek unapproved and potentially damaging treatments. Despite nondiscrimination provisions of the Affordable Care Act, health insurance carriers discourage individuals from selecting their plans by designing benefits that create financial hurdles for persons with preexisting chronic medical conditions. We conducted an analysis of several states’ 2019 and 2020 on-exchange insurance plans for FDA-approved treatments to illustrate adverse tiering practices. Our analysis showed that in the majority of states, first-line treatments were consistently placed on the highest tier or not covered and high cost-shares were typically applied to generic drugs, leading patients to pay significantly high prices per month. Other discriminatory practices were exhibited by all plans. Without affordable options, chronic HBV patients may stop taking medication, increasing their risk of developing liver damage.
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