Findings from University of Virginia in HIV/AIDS Reported (Clustering affordable care act qualified health plans to understand how and where insurance facilitates or impedes access to HIV prevention): Immune System Diseases and Conditions – HIV/AIDS

Health Policy and Law Daily

2024 DEC 05 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- New research on HIV/AIDS is the subject of a new report. According to news reporting out of the University of Virginia by NewsRx editors, research stated, “With access to and uptake of pre-exposure prophylaxis (PrEP), the United States can prevent new HIV infections. To end the HIV epidemic, health insurance plans must facilitate access to comprehensive preventive care benefits.”

Financial supporters for this research include National Institute of Allergy And Infectious Diseases.

The news reporters obtained a quote from the research from University of Virginia: “Since plan benefit designs vary considerably by plan, it is difficult to systematically determine plans that facilitate and restrict preventive services for PrEP. We applied an unsupervised machine learning method to cluster 17,061 Qualified Health Plans offered to individuals. We examined the clusters to draw conclusions about the types of benefits insurance companies tend to group together in plans. Then we analyzed the geographic distribution of those clusters across the United States to assess geographic inequities in access to HIV preventive care. Our method uncovered three cohesive clusters of plans. Plans in Cluster 1: the least restrictive cluster, facilitate access to preventive care using copays over coinsurance on almost all benefits; Cluster 2: the moderately restrictive cluster, plans cover HIV prevention benefits with copays but restrict access to general health benefits with coinsurance; and Cluster 3: the most restrictive cluster, plans cover almost all benefits using coinsurance. Overall, increased prior authorization requirements tend to accompany reductions in out-of-pocket costs. Examining the geographic plan distribution, states with at least one rating area where at least 75% of plans offered are in the most restrictive cluster included: Georgia, Illinois, Missouri, Oklahoma, Texas, Virginia, and Wyoming.”

According to the news editors, the research concluded: “Insurance plan design is complex. To address the ambitious call to end the HIV epidemic in this country, plans should also take into account both public health and health equity factors to create plan designs that ensure access to critical preventive services for people who need them most. Addressing the growing disparities in PrEP access along racial and ethnic lines should be a national priority, and federal and state insurance regulators as well as insurance plans themselves should be part of the conversation about how to ensure people who would benefit from PrEP can access it. Better state/federal regulation of plan design to ensure access is consistent, equitable, and based on clinical recommendations will reduce the variability across plan designs.”

For more information on this research see: Clustering affordable care act qualified health plans to understand how and where insurance facilitates or impedes access to HIV prevention. AIDS Research and Therapy, 2024,21(1):1-13. (AIDS Research and Therapy - http://aidsrestherapy.biomedcentral.com). The publisher for AIDS Research and Therapy is BMC.

A free version of this journal article is available at https://doi.org/10.1186/s12981-024-00674-9.

Our news journalists report that more information may be obtained by contacting Samuel D. Powers, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia. Additional authors for this research include Karen M. Schmidt, Amy Killelea, Andrew Strumpf, Kathleen A. McManus.