HIV POLICY UPDATE

November 15, 2018

United Healthcare Launches Patient Cash Incentive to Take Cheaper HIV Regimen

United Healthcare, the largest health care insurer in the U.S., recently launched a program called “My ScriptRewards” that offers qualified participants an opportunity to earn up to $500 per year in the form of pre-paid debit cards to be used for medical expenses. These are earned by accepting a lower-cost regimen of approved HIV medications. The program is open only to people who have employer-based insurance or are self-insured. Its launch is underway in all 50 states but is proceeding faster in some than in others. Currently, the program engages only people living with HIV, although United Healthcare plans to expand it in the future to people with other chronic conditions.

United Healthcare’s press release describes the participant’s first step as “consulting their doctor” to choose a lower-cost regimen appropriate to their needs. This is followed by filling the program-eligible (i.e. low cost) prescription and activating their ScriptRewards account on line or by phone. They then receive a $250 prepaid debit card by mail that can be used to cover any other medical expenses, including medical visits, supplies, or co-pays to reduce the cost of other essential prescriptions such as diabetes medications, contraceptives, etc. If fully adherent to the program, the patient can receive another $250 debit card in six months.

United Healthcare is a diversified healthcare company whose U.S. network includes nearly one million health care providers, 5,600 hospitals and 67,000 pharmacies. It is owned by the UnitedHealth Group, a diversified company active in over 130 countries that processes approximately one trillion transactions annually.

United Healthcare’s materials assure patients in My ScriptRewards will enable them to “choose a lower-cost regimen right for them” and then “fill an eligible prescription at their pharmacy for $0 out-of-pocket.” They further note that: “There are several HIV treatment regimens recommended by the Department of Health and Human Services” and that their “plan participants can receive certain guideline-recommended HIV medications with proven effectiveness for no cost at the time of purchase.”

What is not addressed is that – if the provider recommends against lower-cost prescription (which is usually an older treatment option) and prescribes a higher-priced (usually newer) one – the patient has to make a choice between trusting the provider and foregoing the Program’s cash incentive or the alternative, declining the provider’s recommendation, accepting an the older, less expensive medication, and getting the debit card. Someone in need of multiple prescriptions and/or experiencing financial hardship may understandably choose the latter — accepting cheaper HIV medication in order to get money to meet other needs. The program’s inducement may raise potential issues for providers and runs the risk of imposing a strain on the patient/provider relationship.

The Academy is examining this issue, specifically gathering information on how widely the Program has been introduced in the U.S. and how providers are responding to it. We are very interested in knowing how our members think the Academy should respond, if at all. Please feel free to forward your thoughts and recommendations to Anna Forbes, Public Policy Director, at anna@aahivm.org.

Increasing Access to HVC Treatment

Last week, the Illinois Department of Health and Family Services (HFS) ended its policy of rationing Medicaid recipients’ access to drugs to cure hepatitis C (HCV). Until now, recipients were not eligible for treatment to cure their HCV until they experienced severe liver damage. Some were also required to provide proof of sobriety in order to receive treatment.

This policy change is the result of a class action challenge brought by the AIDS Foundation of Chicago (AFC), the (Chicago-based) Legal Counsel for Health Justice and the Center for Health Law and Policy Innovation at Harvard Law School. In its press release, AFC notes that, “This new policy makes a recognized hepatitis C cure—Direct Acting Antivirals, or DAAs—accessible for thousands of Illinoisans, many of whom were previously denied treatment until they reached end-stage disease.”

The CDC estimates that 25% of the 1.2 million Americans living with HIV are co-infected with HCV. A recent report by the Center for Health Law and Policy Innovation (CHLPI) and National Viral Hepatitis Roundtable’s (NVHR) states that, “Hepatitis C is our nation’s deadliest infectious disease, yet many state Medicaid programs have discriminatory restrictions that keep Americans from being cured and stop us from ending the epidemic.”

To date, it adds, “twenty-one states have either eliminated or reduced their fibrosis restrictions, nine have loosened their sobriety restrictions, and six have scaled back their prescriber restrictions.” However, it concludes, “there are still far too many restrictions in place in Medicaid, private health insurance and correctional settings.” More information on the state of Medicaid HCV treatment access, including a state-by-state description of current policies, is available at www.stateofhepc.org.