Cost of Treatment in USA

Question

I just finished reading Doctor Joel Gallants Blog which like yours is very well known.

A reader said with his new monthly insurance makes Odefsey co-pay $850 a month. Is this common in the United States? How does anyone afford treatment there?!

Answer

Hello and thanks for your post and words.

A $850 copayment per month is fortunately very unusual. This might be a person with a mandatory medication cost deductable that must be met before insurance benefits kick in. Or, it's someone with a bad coinsurance plan where the person pays a substantial percentage of the cost of medications.

Fortunately, access to HIV treatment in the US is generally very good, through a patchwork of private and public insurance programs as well as government and pharmaceutical industry assistance programs.

For low income individuals, the Ryan White Care Act and the AIDS Drug Assistance Program (ADAP) covers many individuals at little or no cost.

As for insurance programs, the cost of the insurance premium, copayment (or as this unfortunate reader might have) and coinsurance costs can vary tremendously. It's my opinion that it's critical that people living with HIV and their caregivers understand what the details of medication costs are with any insurance plan. Often plans with low premiums come at the expense of high copayment or coinsurance (where the individual pays a percent of the total cost of medications)- these plans should be avoided if possible.

Most HIV pharmaceutical companies offer quite large patient assistance programs (upwards of several thousand USD per year) that cover copayment or coinsurance out of pocket costs, or for uninsured individuals, free medications. While helpful for individuals, it's my opinion that such patient assistance programs blunts recognition and opposition of the high retail cost of medications.

Ultimately, it's critical that all people living with HIV have access to affordable and non-stigmatizing care environments for testing, care and medications. If we can ensure that this happens, we can end the epidemic of AIDS and make new cases of HIV a rare thing. Aspirational perhaps, but many jurisdictions are accelerating their community responses to HIV testing, linkage to care, treatment access- leading to dramatic improvements in community viral suppression. There's much work to do in the US; despite obvious differences in income and wealth, several countries, including Malawi and Botswana have higher levels of HIV treatment and viral suppression than the US. This will be the challenge for all of us in HIV care for the next years.

Be well, BY