1. Review of Florida Qualified Health Plans: Implications for Plan Choices Jesse Fry Policy Analyst May 7, 2015

2. 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 OIR The AIDS Institute

3. Florida Reasonable Cost-sharing Plans: 2015 - HIV The AIDS Institute QHP IssuerBenefit DesignCost-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

4. The AIDS Institute QHP IssuerBenefit DesignCost-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

5. Florida High Cost-Sharing Plans: 2015 - HIV The AIDS Institute IssuerBenefit DesignCost-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

6. The AIDS Institute IssuerBenefit DesignCost-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

7. 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

8. 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

12. 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

13. THANK YOU Jesse Fry Policy Analyst jfry@theaidsinstitute.org www.theaidsinstitute.org