Join the Community Health Training Alliance for a series of webinars in June to discuss the importance of HIV prevention, treatment, and justice against racial and social inequities in healthcare. On Monday, June 21st, 2021 from 11:30am -1:00pm ET, Michaela Jackson, M.S., MPH, Prevention Policy Manager at the Hepatitis B Foundation will present “The True Cost of Discriminatory Hepatitis B Drug Tiering.” This session will discuss previous research on several states’ 2019 and 2020 on-exchange insurance plans for FDA-approved treatments to illustrate adverse tiering practices.

Register here.

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 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. 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.