Getting HIV Drugs in the U.S.
November 28, 2015
Table of Contents
Health insurance covers some of the cost of prescription drugs, including HIV drugs. The best way to get health insurance is to work for an employer who provides it. Some employers, especially small businesses, do not offer health insurance. If this is the case, you may be able to buy an individual insurance plan directly from an insurance carrier.
If you do not work, or your employer does not offer health coverage, you can also check to see if you qualify for any public health insurance programs (e.g., Medicaid and Medicare below). People living with HIV who need help paying for HIV drugs may qualify for medication coverage through their state drug assistance programs (see AIDS Drug Assistance Programs below). Some clinics now have patient navigators, social workers, case managers, or insurance specialists; any of these professionals can help you get the coverage you need.
Most insurance plans include some drug coverage. However, co-pays add up. Some people choose to get their medicines from mail-order pharmacies. Mail-order pharmacies can have benefits like lower co-pays and home delivery of medications. However, it is important to realize that mail-order pharmacies -- like local pharmacies -- can make mistakes. When they do, it can take a few days for the correction to be made. You may want to speak to your insurance carrier and your health care provider about using a mail-order pharmacy to see if it is a good option for you.
The Affordable Care Act (ACA) was signed into law by President Obama in 2010. The ACA provides for several changes that can dramatically improve the health of people living with HIV (HIV+) by increasing their access to health care. For example, it stops insurers from denying coverage to those with pre-existing conditions (like HIV or pregnancy) and stops insurers from putting lifetime or annual spending limits on insurance benefits, which often affect those living with long-term conditions like HIV. The ACA has also increased women's coverage for reproductive health care (e.g., birth control, cervical cancer screenings).
The ACA creates health insurance marketplaces for people to buy affordable health insurance if they do not have access to employer-based programs. It also provides for changes to many programs that already help people living with HIV get their HIV drugs, like Medicaid and Medicare. For more information, read about each of the specific programs below and see The Well Project's article, The Affordable Care Act and Women in the US.
If you do not have access to insurance offered by an employer or do not qualify for Medicaid, you can look for affordable health insurance through the health insurance marketplaces. These marketplaces for individuals and families are available either through your state, if it chose to set up a marketplace, or through the federal government, if your state chose not to participate. Click here to learn more about enrolling in the federal marketplace.
For those who have trouble paying, there are federal tax credits and subsidies (money the government gives you) for people with low and middle incomes to help make the insurance premium more affordable.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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