An SFAN member brought up a problem that some of his clients had reported. John Marangio reported on the treatment of Hepatitis C, an infection that co-occurs frequently with HIV infection.
Cliff Eserman (Incompas Insurance) reported that insurance companies have cancelled the insurance of some RWC clients. Those clients at risk have transitioned to Affordable Care Act (ACA) plans and have incomes that vary throughout the year. This variability causes their ACA subsidies to change. When the FL-Department of Health learns of changes to the subsidy, they cease paying the premium, but fail to notify the client.
They do this relatively late in the payment cycle, leaving the client without an option to correct the problem. The client knows nothing about this cancellation until their insurance company sends them a cancellation notice. The client then can go back to Ryan White Care (RWC), which only covers HIV conditions.
Mara Burger (FL-DOH) reported that the AIDS Drug Assistance Program (ADAP) does not manage the subsidies for ACA plans. The Federal-State Health Insurance Marketplace manages the subsidies, calculates them, and requests clarifying information about income and household. Burger stated, “Insurance is not immediately cancelled when their subsidy changes without giving them the opportunity to make up the difference.”
As of press time, it was not possible to clarify two facts: 1) how much notice is given to clients that a problem exists with their insurance subsidy, and 2) whether FL-DOH or the Marketplace Exchange has the responsibility to notify the client that a problem exists with their insurance.
According to the CDC, the Hep C virus infects the liver, with about 75 percent of infected people developing a chronic infection. People can spread Hep C in several ways: through sharing injecting or snorting equipment, getting amateur tattoos or body piercings, or having “rough” sex. Hep C infection can last for years with no visible symptoms. The CDC recommends that all people with HIV infection, all Baby Boomers, and all people who have “rough sex” take a Hep C test. Alan Ginsberg, author of Howl, died of Hep C infection in 1997.
John Marengo reported that new treatments for Hep C can cure patients in only twelve weeks. Marangio recommended that providers attend educational dinners hosted by pharmaceutical companies to learn the technical aspects. The major problems with these treatments involve adherence to a prescribed regimen and resistance to the drug. Drug resistance refers to a virus that has evolved to resist the effects of a particular drug, making that drug useless for that infected person. Adherence refers to taking the drug as prescribed. Strict adherence prevents the infecting virus from evolving to resist treatment. Combination pill treatments for Hep C can reduce issues with adherence.
Marengo stressed that Specialty Pharmacies have the resources to help patients having problems with adherence or drug resistance. Just as treating HIV infection requires specialized knowledge, treating Hep C requires specialized knowledge.
In HIV news, the AIDS Institute has launched a new website focused on AIDS and aging issues www.nhaad.org. Worldwide 3.6 million people living with HIV infection are fifty or older.
On July 14, UNAIDS announced that the goal of getting 15 million people living with HIV into treatment has been achieved, nine months ahead of schedule. To read the UNAIDS report on how AIDS changed everything, please visit
Next SFAN Meeting: Friday, August 7, at 10:00 a.m., at the Holy Cross Healthplex, 1000 NE 56th Street, Ft. Lauderdale, FL 33334. Newcomers are encouraged to attend.
The South Florida AIDS Network (SFAN) functions as the networking/advisory body for the Ryan White Care (RWC), Part B grant in Broward County. Its monthly meetings are open to the public.