3199.0: Monday, November 13, 2000 - Board 0

Abstract #3040

Private health insurance coverage of HIV medications

Robert J. Buchanan, PhD, School of Rural Public Health, Texas A&M University System Health Science Center, 260 Centeq Building, College Station, TX 77843-1266, 409-458-2242, buchanan@medicine.tamu.edu, Scott R. Smith, PhD, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7360, 919-966-7558, scotts@email.unc.edu, and Bonnie J. Chakravorty, PhD, Community Health Program, Tufts University, 112 Packard Avenue, Medford, MA 02155, 617-627-3233, bchakrav@yahoo.com.

Drug therapies for the treatment of HIV and related opportunistic infections are among the primary weapons to increase the length of survival and to improve the quality of life for people living with HIV. Depending on the stage of illness, private health insurance provides coverage to between 26 and 31 percent of people with HIV disease. Hence, private health insurance coverage of prescription medications impacts the access to HIV-related therapies for many people. This study presents the results of a survey of state insurance commissioners, describing state regulation of the prescription drug coverage provided by private health insurers. The study addresses state regulation of medication coverage by conventional health insurance and managed care organizations. The study presents any state regulation of insurers' ability to restrict drug utilization, place dollar caps on utilization, impose copayment responsibilities, allow off-label use, and administer retricted formularies. In addition, the survey addresses any impending changes in state regulation of the prescription drug benefit provided by private health insurance.

Learning Objectives: To identify state-level policies regulating the coverage of HIV medications by private health insurers and managed care organizations

Keywords: HIV/AIDS, Health Insurance

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA