The National Health Law Program (NHeLP) and the AIDS Institute have filed an administrative complaint with the Department of Health and Human Services’ Office for Civil Rights alleging that four insurance companies in Florida unlawfully discriminate against enrollees with HIV and AIDS.
In particular, the complaint accuses Coventry Health Care Inc., Cigna Corp., Humana Inc. and Preferred Medical of charging “inordinately high co-payments and co-insurance for medications used in the treatment of HIV and AIDS.”
Wayne Turner, a staff attorney with the National Health Law Program, explains the basis for the complaint.
“We were approached by people with the AIDS Institute - they’re a Florida-based HIV and AIDS advocacy organization - and they conducted a review of the silver-level plans available through the health insurance marketplace in Florida,” Turner explains. “They found problems – issues with some of the health plans, but there were four health insurers that really stood out. These four health insurances offered all HIV medications in their highest tiers.”
Turner notes that in addition to excessive out-of-pocket expenses, tier 5 drugs also limit quantities available to enrollees. In addition, he contends that the requirement of prior authorization also presents a barrier to anti-retroviral drug access.
“What really stood out was even generic versions of medication were in tier 5. All four plans were placing generic drugs that have been out in market for a long time in its highest tiers,” Turner said.
“This is a plan benefit design that’s designed to discourage people from HIV and AIDS from enrolling in plans.”
Under the Affordable Care Act, it is illegal to deny coverage based on preexisting conditions, or discriminate against enrollees because of their present health status.
Turner argues that this bias presents difficulties for certain populations who already struggle obtaining insurance.
“The thing that concerns us about Florida is Florida has not yet adopted the new Medicaid expansion for adults,” he said. “People at lower level income levels, people with HIV/AIDS, people below the poverty level, instead of getting enrolled in a Medicaid program, they have to rely on coverage obtained in marketplaces. Even if they get a subsidy, they still have to come up with a lot of money to meet copays and coinsurance and out of pocket expenses.”
In addition, from a commercial perspective, Turner worries that the four insurers’ “overly restrictive utilization management” has the potential to destabilize the health insurance industry.
What happens in year two, do you think that provider is going to keep their their AIDS drugs in a range of tiers, or are they going to duplicate what a bad actor has done and put all drugs in tier 5? We think the latter – it’ll turn into a race to the bottom in which all health plans, not just four bad actors, are looking to create AIDS drug benefits that discourages people from enrolling.”
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