IN THE LOOP

Do you use a copay card to help pay for drugs for HIV treatment or PrEP? If you do, watch out – your insurance company might have a new policy that doesn’t let your copay card count toward your deductible and out-of-pocket maximum. Known in the industry as “copay accumulators,” these policies are increasing the cost of meeting annual deductibles and out-of-pocket spending limits, leaving people on PrEP or those living with HIV or hepatitis C priced out of the treatments they need.

Here’s how it works. Drug companies sometimes offer copay cards to help lower the cost of expensive medications, including drugs for HIV treatment and PrEP. Health insurers in general have allowed the drug company assistance to count towards patients’ annual deductibles or out-of-pocket spending limits. But now some companies are reversing course. Although they will still accept the copay card, when you reach your limit on the card, the total value of the card will not count toward your deductible or out-of-pocket maximum. If this policy is in place with your health plan, you will need to pay your full deductible out of your own pocket before your insurance actually kicks in.

Health plans are implementing these policies with no consumer notice. Patients usually discover the policy is in place mid-year, when the drug company financial assistance runs out, leaving them responsible for potentially thousands of dollars to cover the costs of their medications. These policies are unfair to consumers and will force more people to go without treatment or, in the case of PrEP, without the protection they need. Also, for people living with HIV, hep C or using PrEP, there are essentially no lower-cost generic medications to take in place of expensive brand name drugs.

APLA Health along with other local, state and national advocates is alerting state attorneys general and insurance commissioners about these new policies. We have posted the letter that went to California’s Department of Managed Healthcare, which oversees most health plans in the state. We encourage you to consult your health plan materials or call your insurer to ask questions about this new policy. If your health plan has instituted this accumulator policy, or you have been hit with increased out-of-pockets cost for your medications, we want to hear from you. Please contact us at governmentaffairs@apla.org.

Last week, the Food and Drug Administration (FDA) approved Truvada® as pre-exposure prophylaxis (PrEP) for adolescents. Although Truvada® was first approved for PrEP in 2012, the indication only included individuals age 18 and older. The new approval expands this indication to include adults and adolescents at risk for HIV who weigh at least 35 kilograms (77 pounds).

The new approval is based on a study by the Adolescent Medicine Trials Network for HIV/AIDS, which examined 67 gay and bisexual men ages 15 to 17. The study found that the side effects of Truvada® as PrEP among these adolescents were comparable to those observed in adult studies. The most common side effects included headache, abdominal pain, and weight loss.

The news was welcomed by advocates across the country, as adolescents continue to be disproportionately impacted by HIV. Youth under 24 years old accounted for approximately 1 in 5 of all new HIV infections in California in 2016. APLA Health will continue to help increase awareness and use of PrEP among all those who may benefit from it, particularly young Black and Latino gay and bisexual men.

You can read the full press release here.

Last week, the California Department of Public Health (CDPH) released a brief with preliminary data on rates of sexually transmitted diseases (STDs) in California for 2017, including reported numbers of gonorrhea, chlamydia, syphilis, and congenital syphilis cases. This is the fourth year in a row that STD rates have hit a new record high in California, and Los Angeles County’s rates have skyrocketed over the past year.

There were more than 300,000 reported STD cases in California in 2017, an almost 45% increase since 2013. Total STD cases in Los Angeles County increased by almost 11% in just one year, from 83,405 cases in 2016 to 92,407 cases in 2017. Los Angeles County now has the third-highest rate of gonorrhea in the state with 26,160 cases, the eighth-highest rate of chlamydia with 64,225 cases, the ninth-highest rate of primary and secondary syphilis with 1,975 cases, and the fourteenth-highest rate of congenital syphilis with 47 cases.

Notably, California has seen a spike in the number of syphilis cases among men who have sex with men (MSM), particularly among young men of color. According to CDPH, men who have sex with men are 38 times more likely than other men and 119 times more likely than women to have syphilis, and MSM living with HIV are 11 times more likely to have syphilis. African American women are six times more likely than white women and three times more likely than Latina women to have syphilis. The preliminary data from CDPH did not include rates among transgender persons.

While there does not appear to be a clear reason for the significant increase in STD rates, it is clear that too many people are not accessing sexual health services nor getting screened frequently enough. It is important to get tested regularly if you are sexually active, even if you do not have symptoms. Many who are infected with an STD do not know it, and while most STDs are easily curable with antibiotics, if left untreated they can cause serious health problems, especially for people living with HIV.

Remember to get tested every 3-6 months. APLA Health offers free and confidential HIV and STD testing and treatment at our Gleicher/Chen Health Center in Baldwin Hills and at our Long Beach Health Center. Walk-ins are welcome!

APLA Health provides services to more than 14,000 people, and we want to know their stories. Have you been receiving services from APLA Health? Are you a new patient or client? Have you or a loved one been affected by HIV and AIDS? Has a staff member gone above and beyond what you were expecting?

We want to know the full story. What are we are doing well? How we can serve you better?

Tell us your story!