(Washington, DC)­­ –The DC Health Benefit Exchange Authority (DCHBX) Executive Board voted to adopt a new benefits design to address health disparities for patients with heart disease (cardiovascular disease) and cerebrovascular disease (including stroke survivors). The benefit design was developed by its stakeholder Standard Plans Working Group with help from a nationally recognized cardiologist identified through the American Heart Association.

Starting in Plan Year 2025, individuals covered by a DC Health Link standard plan will no longer have copays, coinsurance, and deductibles for visits with their primary care doctor (including family medicine or internal medicine doctor) for cardiovascular and cerebrovascular care. The DCHBX Executive Board also removed cost sharing for all generic prescription drugs and services related to the prevention and treatment of cardiovascular and cerebrovascular disease, as well as for laboratory tests and imaging including CT scans and electrocardiograms.

Heart disease was the leading cause of death in the United States in 2020, according to research published in the American Heart Association journal Circulation. The rate of Black DC residents who die from heart disease is 2.5 times higher than White residents. Additionally, 10.1% of Black residents and 12.9% of Hispanic/Latino residents compared to 6.1% of White residents report not seeing a doctor because of cost.

“Eliminating cost sharing for cardiovascular and cerebrovascular disease, conditions that disproportionally impact communities of color, will save lives,” said Diane C. Lewis, M.P.A., Chair of the DCHBX Executive Board and Chair of the DCHBX Social Justice and Health Disparities Working Group. “DCHBX is committed to addressing health disparities and getting to equity in health coverage and care.  We are using every tool available to us in our state-based marketplace.  We know that financial barriers to care is a major contributor to differences in health outcomes.  Our actions today will improve access to care and will narrow the significant differences in health outcomes based on race and ethnicity. And most importantly, we will help save lives.”

The action taken by DCHBX Executive Board means that starting in 2025, more patients with heart disease or cerebrovascular disease can get the care they need.  Patients who need a CT scan will no longer have to pay $500, the required co-payment in Bronze coverage for CT scans after meeting the annual deductible.  These changes apply to DC Health Link standard plans available in the small group and individual and family marketplace.

This action is the latest step DCHBX Executive Board has taken to implement policy changes developed by its Social Justice and Health Disparities Working Group designed to stop systemic racism in health care. For plan year 2024, DCHBX Executive Board reduced copays for children covered by a standard plan on DC Health Link to a $5 copay, with no deductibles, for outpatient mental health visits, including specialist visits, and no limit on the number of visits.  The Board also reduced prescription copays for child mental health care to $5, with no deductibles.  For Plan Year 2023 Standard Plans, DCHBX Executive Board eliminated cost sharing for outpatient Type 2 Diabetes care and services including physician visits, blood tests, vision and foot exams, prescription medications, and supplies including insulin.  No copays, coinsurance, and deductibles.  Type 2 diabetes also disproportionally impacts communities of color in the District.

The DCHBX Executive Board resolution eliminating cost sharing for cardiovascular and cerebrovascular disease is available here.

Zero Cost Sharing for All Generic Medications and Services Related to the Prevention and Treatment of Cardiovascular Disease

Table 1: ICD Codes

Table 2: Medication Classes/Groups

Table 3: Laboratory Tests

Table 4: Treatment Scenarios

Unlimited New and Follow Up Visits at Zero Cost-Sharing

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