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  • Drug Benefits Covered by the Essential Health Benefits

    HIVMA and RWMPC urged Secretary Sebelius to ensure the essential health benefits that provides people with HIV with access to the standard for HIV treatment set by the Department of Health and Human Services HIV treatment guidelines.

    The proposed minimum drug coverage standard is below that offered by most private insurance plans and falls well short of covering the basic standard of care for HIV treatment that requires a minimum of three antiretroviral agents prescribed according to factors unique to the individual patient. Exorbitant cost sharing and burdensome prior authorization processes already pose serious barriers to obtaining HIV antiretroviral agents for many of our HIV-infected patients with poor insurance coverage.

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