Connecticut has been a national leader in implementing the Affordable Care Act through its Access Health CT marketplace and we applaud the progress that has been made to ensure health coverage for residents in the state.

However, with implementation comes hurdles, and it has become clear that there are still issues that need to be addressed to ensure that Connecticut consumers have access to comprehensive coverage and the information they need to choose the right health plan for their needs.

The HIV/AIDS community is among certain populations of people living with chronic disease that were identified in a recent study conducted by Avalare Health as facing obstacles when accessing their medications. In various states across the country it was found that some insurers were placing all medications for certain chronic conditions like HIV/AIDS solely on the top tiers of their plan formularies. For HIV/AIDS drugs, this includes generics. Further, the study found that depending on the plan, some consumers faced high co-insurance rates for their medications, some as high as 30 percent or more.
Managing chronic illness, such as HIV/AIDS, cancer, MS, or epilepsy, requires strict adherence to drug therapies and can often involve treating a host of other additional ailments. Oftentimes, there is a certain combination of drugs that is required to be taken and one type of medication certainly does not work for all patients.

There is a very real danger in not having access to vital prescriptions for patients living with a chronic condition. When health insurance companies place drugs on the highest tiers, charge more for those drugs in co-insurance costs, or do not provide cost details up front in a consumer-friendly format, patients often cannot afford their medicines or choose to go without them because of prohibitive or unexpected costs.

Currently the Connecticut legislature is considering Senate Bill 24, which will provide consumers with important plan information that should be easily accessible when shopping for and comparing health insurance plans. In addition, the bill will require an annual review by the Insurance Commissioner on plans being sold both on and off the marketplace to create a level of protection against unfair and discriminatory drug formularies.

Specifically, Senate Bill 24 will require all insurers selling health plans in Connecticut to make available in an easily understood manner 1) what benefits are covered, 2) which drugs are included on their formularies and the associated cost-sharing for each, and 3) which physicians and hospitals are in-network. Without this vital information, consumers will find it difficult to purchase a plan that fully meets their needs. This can lead to higher costs, less adherence, and potentially more health complications down the road.

The AIDS Institute has been proud to speak out and fight against discriminatory formulary practices. In Florida, we joined with the National Health Law Program to fight these practices and we are winning major victories for patients. While our work is not over, more people living with HIV/AIDS will now have the option to purchase plans that include brand specific and generic drugs on affordable tier levels in the state of Florida and around the country.

Right now, the Connecticut General Assembly has the opportunity to better identify and remedy discriminatory plan benefit designs and ensure full transparency of benefits so consumers can choose the best health plan for their unique needs. By supporting the passage of Senate Bill 24, Connecticut leaders can ensure their constituents have access to the quality care they deserve and the medicines they need to live happy, healthy, and productive lives.

Carl Schmid, a native of Fairfield County, is deputy executive director of The AIDS Institute, Washington, D.C.

DISCLAIMER: The views, opinions, positions, or strategies expressed by the author are theirs alone, and do not necessarily reflect the views, opinions, or positions of