This World AIDS Day, there’s a lot to celebrate. In the 1980s, when the first cases of what was then a mysterious illness were diagnosed in the United States, HIV/AIDS was considered a death sentence. Effective treatments took decades to develop. Thankfully, antiretroviral therapies and other innovations have dramatically improved the prognosis, allowing people with HIV to live full, active lives.
But while remarkable progress has been made, these lifesaving medications come at a cost. In 2021, caring for patients with HIV/AIDS is less of a medical or scientific problem than a socioeconomic one. On average, a person with HIV spends nearly half a million dollars on related healthcare and treatment over the course of their lifetime. The cost of HIV therapy is estimated at $2,000 per month. These figures are likely to rise as out-of-pocket drug costs increase.
For far too many patients, particularly members of vulnerable communities, these expenses are simply unaffordable. One CDC study found that 7% of people with HIV did not adhere to treatment due to prescription drug costs. Those who skipped doses, took less medicine, or delayed prescriptions because of cost concerns were more likely to seek care in emergency departments or be hospitalized, services that are more costly to the medical system than routine outpatient care. They were also more than twice as likely not to be engaged in HIV medical care, leading to poorer health outcomes. In addition, they were less likely to have sustained HIV viral suppression, which increases the risk of transmission.
Fortunately, cost-saving resources are available. Here are three ways providers and pharmacies can help patients overcome financial barriers to HIV care:
1. Proactively Identify At-Risk Patients
Discussions with HIV patients about costs of care should be part of a comprehensive, holistic treatment plan. In a recent survey, only 20% of physicians were able to accurately estimate patient out-of-pocket drug expenses. As a result, patients may be blindsided by prescription drug costs and those who are at high risk of financial distress may fall through the cracks. Having informed, proactive conversations—at the beginning of a patient’s care journey—can play a critical role in identifying those who may need financial assistance. This is the first step to ensuring that HIV patients have the resources they need to afford care.
2. Build Awareness Around Available Funding
While HIV-related expenses may seem daunting, it’s important to let patients know that they may be eligible for a variety of funding opportunities. Virtually every major HIV drug manufacturer offers financial assistance to patients who cannot afford their medications. This includes co-pay assistance programs for those with insurance, as well as patient assistance programs (PAPs) that provide free or low-cost drugs to people who don’t qualify for insurance.
Government-funded programs can also help reduce patient expenses. The Health Resources and Service Administration’s Ryan White HIV/AIDS Program partners with cities, states, and community-based organizations to provide HIV-related services to those who do not have sufficient healthcare coverage or financial means. It includes support for the AIDS Drug Assistance Program (ADAP), which provides medications to low-income Americans. Medicaid is another key source of health coverage for eligible HIV patients. Medicaid expansion under the Affordable Care Act has reduced the number of people with HIV who are uninsured, improving access to medication and care. For people 65 and over, Medicare covers all medically necessary HIV treatment.
In addition, patients may be eligible for funding from charitable organizations such as the Patient Access Network Foundation (PAN), Good Days, and the Patient Advocate Foundation. These foundations offer grants that can help offset out-of-pocket costs for prescribed HIV treatments. Some funds also assist with living expenses, transportation, and other costs associated with treatment.
These are just a few examples of the many resources available to reduce patients’ financial burden. By building awareness of these resources—with the support of financial navigators and case managers—providers and pharmacies will improve the likelihood that patients adhere to treatment.
3. Engage Patients Around Health Insurance
Under the Affordable Care Act (ACA), most employer-based and individual insurance plans offer new benefits and protections, including for people with HIV. However, many American patients are ignorant of what their plans offer. In one survey, more than 25% of healthcare consumers said that they avoided care because they were unsure of what their insurance covered and more than 50% didn’t know what a co-pay was. Among those without insurance, 90% couldn’t identify the open enrollment period to sign up for an ACA plan. Given these statistics, it’s crucial to engage HIV patients about their benefits and help them optimize their coverage.
When enrolling in a plan—whether through an employer, the Health Insurance Marketplace, or privately—HIV patients have a complex set of considerations due to the high costs of treatment. By arming patients with information on what to look for in terms of co-pays, deductibles, premiums, and more, they will be empowered to select insurance policies that enable them to afford care.
To Fight AIDS, Remove Financial Barriers
World AIDS Day is an occasion to honor the more than 36 million people, including 700,000 Americans, who have lost their lives due to AIDS-related illness since the start of the epidemic. It’s also a time to reflect on the incredible advancements in HIV research, prevention, and care that have reduced transmissions and turned a deadly disease into a manageable illness. However, the fight against AIDS is not over—and high costs prevent far too many people with HIV from accessing lifesaving care.
By proactively identifying patients in need, building awareness about cost-saving opportunities, and optimizing health coverage, providers and pharmacies can play a crucial role in improving access to care. Technology can help streamline the process and connect patients with the resources they need. Taking these proactive steps not only reduces financial distress for patients and their families, but for the entire healthcare system.
We’ve come so far in the fight against AIDS. Now let’s make sure that the strides we’ve made benefit everyone, regardless of their financial circumstances.
Srulik Dvorsky
CEO, TailorMed
