review of florida qualified health plans: implications for plan choices jesse fry policy analyst may...
TRANSCRIPT
Review of Florida Qualified Health
Plans:Implications for Plan
ChoicesJesse Fry
Policy AnalystMay 7, 2015
Overview: Review of Florida’s Qualified Health Plans
• Summaries of Plans’ Drug Benefits• Focus on Cost Sharing• How to access our full review – Electronic
Spreadsheet• Fluid environment• Links to health insurance company Web
sites• Frequency of updates; accuracy of online
formularies• Update on The AIDS Institute’s and NHeLP
complaint• Recent formulary and cost sharing changes
per OIRThe AIDS Institute
Florida Reasonable Cost-sharing Plans: 2015 - HIV
The AIDS Institute
QHP Issuer Benefit Design Cost-Sharing
Ambetter
• Almost all HIV Drugs on Tier 2 or 3• 2 Drugs on Tier 4
• Tier 2 Copay $50• Tier 3 Copay $100• Tier 4 Coinsurance 30%• Must first meet $1,000
Rx Deductible
Blue Cross• Almost all HIV Drugs on Tier 2• Some on Tier 3• Only 1 Drug on Tier 4
• Tier 2 Copay $70 • Tier 3 Copay $100• Tier 4 Copay $150
FL Health Care Plans
• All but 1 HIV Drug on Tier 3• Only 1 Drug on Tier 6 (with generic on
Tier 2)
• Tier 2 Copays Range $10 - $27
• Tier 3 Copays Range $30 - $87
• Tier 6 Coinsurance 20%• Must first meet $400 Rx
Deductible
The AIDS Institute
QHP Issuer Benefit Design Cost-Sharing
Humana
• 6 HIV Drugs on Tier 2• 7 Drugs on Tier 3• For 22 Drugs, on Custom Tier of
10% of Cost
• Tier 2 Copay $20• Tier 3 Copay $50• Must first meet $1,500 Rx
Deductible except for Tiers 1 and 2
Molina
• All but 2 HIV Drugs on Tier 2• 2 Drugs on Tier 4
• Tier 2 Copay $50• Tier 4 Coinsurance 30%• Must first meet $200 Rx
Deductible
United Healthcare
• Most HIV Drugs on Tier 2• A couple on Tier 3• 3 Drugs on Tier 4
• Tier 2 Copay $40• Tier 3 Copay $80• Tier 4 Copay $160
Florida Reasonable Cost-sharing Plans: 2015 - HIV
Florida High Cost-Sharing Plans: 2015 - HIV
The AIDS Institute
Issuer Benefit Design Cost-Sharing
Aetna & CoventryOne
• All but 1 Brand HIV Drug on Tier 5• Agreed to Cap Copay at $200 for 4
Drugs
• Tier 5 50% co-insurance• Must first meet $500 Rx
Deductible
Cigna• All Brand HIV Drugs on Tier 5• Agreed to Cap Copay at $200 for 4
Drugs
• Tier 5 30-50% coinsurance• Must first meet $2,750
Deductible
Health First• All HIV Brand & Generic Drugs on
Tier 5• Tier 5 30% co-insurance• Must first meet $500 Rx
Deductible• Prior Authorization for most
Preferred Medical
• All Brand HIV Drugs on Tiers 4 & 5• Agreed to Cap Copay at $200 for 4
Drugs
• Tiers 4 & 5 50% co-insurance
• Must first meet $1,500 Rx Deductible
The AIDS Institute
Issuer Benefit Design Cost-Sharing
Assurant
• All HIV Drugs on Tier 2
• No cost after $3,500 Deductible is met
• No cost-sharing information available
• Impossible to determine cost-sharing prior to enrollment
Florida Plans Unknown Cost-sharing: 2015 - HIV
Aetna/Coventry Nationwide Formulary Changes
• Oral Drugs on Generic or Non-Preferred Brand Tier
• Copayments Between $5 and $100 After Deductibles
• Certain plans have separate “prescription deductibles”
• Effective June 1, 2015 All Aetna and Coventry QHPs
• Nationwide, not just Florida• Will Also Apply to QHPs in 2016
The AIDS Institute
Review of Florida’s Qualified Health Plans in the Federal Marketplace
• Focus on quality review in terms of share of cost and drug formulary coverage
• The hope of more informed plan choices by people living with HIV and AIDS
• Reviewed only Silver Plans • www.theaidsinstitute.org/FloridaQHPreview• Encourage downloading the spreadsheet
often• Reasoning about network adequacy review
& lack of it
The AIDS Institute
Review of Florida’s Qualified Health Plans in the Federal Marketplace
• Focus on quality review in terms of share of cost and drug formulary coverage
• The hope of more informed plan choices by people living with HIV and AIDS
• Reviewed only Silver Plans • www.theaidsinstitute.org/FloridaQHPreview• Encourage downloading the spreadsheet
often• Reasoning about network adequacy review
& lack of it
The AIDS Institute
