The True Cost of Discriminatory Hepatitis B Drug Tiering

Monday, June 21st 2021

11:30 AM - 1:00 PM

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Hepatitis B virus (HBV) is the world’s leading cause of liver cancer and is associated with complicated co-infections- HIV/AIDS, hepatitis C, and hepatitis Delta. An estimated 2.4 million individuals in the US and 50,0000 individuals in Pennsylvania are living with chronic HBV. With no cure, those infected often rely on antiviral medications to control the virus. First-line treatments involve daily antivirals to suppress the virus and must be taken for several years. Barriers to access, including high costs, can cause patients to forgo needed treatment, stop treatment prematurely, or seek unapproved and potentially damaging treatments. Despite nondiscrimination provisions of the Affordable Care Act, health insurance carriers discourage individuals from selecting their plans by designing benefits that create financial hurdles for persons with preexisting chronic medical conditions. We conducted an analysis of several states’ 2019 and 2020 on-exchange insurance plans for FDA-approved treatments to illustrate adverse tiering practices. Our analysis showed that in the majority of states, first-line treatments were consistently placed on the highest tier or not covered and high cost-shares were typically applied to generic drugs, leading patients to pay significantly high prices per month. Other discriminatory practices were exhibited by all plans. Without affordable options, chronic HBV patients may stop taking medication, increasing their risk of developing liver damage.



  1. Identify common discriminatory methods utilized by insurance companies to discourage certain groups from choosing a plan
  2. Describe adverse drug tiering practices for hepatitis B medications by insurance companies in Pennsylvania
  3. Discuss the real-world implications of discriminatory drug tiering and the importance of equitable access to treatment


Michaela Jackson

Hepatitis B Foundation

Michaela Jackson has worked to educate and raise awareness on various public health issues at both a local and national level. Her work at the Hepatitis B Foundation currently focuses on implementing public policy initiatives to address hepatitis B and liver cancer prevention.








Andrew C.

Hepatitis B Foundation

Andrew is the spouse of a hepatitis B patient who has been negatively impacted by discriminatory drug tiering. He is a patient advocate who wishes to raise awareness around the high cost of hepatitis B treatments.


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Spotlight On

Karam Mounzer, MD

Dr. Mounzer identified two major gaps in the care of patients with HIV/hepatitis C (HCV) co-infection, and the complexity of multidrug-resistant HIV treatment. He is involved with many clinical trials focusing on drug development and better understanding of HIV immunopathogenesis with the Wistar Institute. He is involved in teaching and mentoring.

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Dr. Karam Mounzer

Dr. Mario Cruz

Dr. Mario CruzDr. Cruz is a board certified pediatrician who serves as the Medical Director for our Pediatrics and Adolescent Health Center. He has presented and/or published in the fields of community violence and domestic violence prevention, quality improvement, behavioral health, curriculum development and mentorship. In 2019 he received the Greater Philadelphia Social Innovation Award for Innovations in Healthcare.

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