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to Section One | to Arts & Entertainment
posted Friday, May 30 2014 - Volume 42 Issue 22
Health organizations file federal complaint against insurance companies over HIV/AIDS coverage
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Health organizations file federal complaint against insurance companies over HIV/AIDS coverage

by Mike Andrew - SGN Staff Writer

The National Health Law Program and The AIDS Institute filed a federal complaint on May 29 against four insurance companies, saying that the firms discriminate against HIV/AIDS patients.

CoventryOne, Cigna, Humana, and Preferred Medical were named in the complaint filed with the Civil Rights Office of the U.S. Department of Health and Human Services (DHHS).

All four insurance companies offer plans in Florida through the online exchange set up under the Affordable Care Act (ACA).

The complaint says that the companies require HIV-positive patients to pay a percentage of the price of their antiretrovirals instead of a flat co-pay, as required for other kinds of drugs. The result is that HIV patients might spend thousands of dollars out of pocket for necessary medicine.

For example, the complaint charges that CoventryOne charges consumers a 40% co-pay for the cost of all HIV drugs, including generics, after a $1,000 deductible.

'That would be about $1,000 per month per drug in most instances. What patient could afford that?' said Carl Schmid, deputy executive director of The AIDS Institute.

Healthcare advocates warn that high costs cause patients to skip doses or go off their medications altogether, causing serious health complications.

The complaint also said that the four insurance companies charged high up-front costs and imposed unwieldy prior authorization requirements on HIV-positive patients.

'Plans do not want to be the preferred plan for people with HIV and AIDS. They do not want that reputation ... plans are going to be restructuring their benefit redesign and emulating what these bad actors have demonstrated,' warned Wayne Turner, attorney for The National Health Law Program.

The complaining organizations said they did not know how many HIV/AIDS patients had purchased health plans from the companies named in the complaint, but a study from the Kaiser Family Foundation estimates about 23,000 uninsured people in the U.S. being treated for HIV and AIDS would be eligible for coverage through the online exchange.

Although the complaint specifically addresses HIV/AIDS patients, other health advocates have expressed concerns about high co-pays for others with serious illnesses that require expensive drugs, including cancer and rheumatoid arthritis.

The Leukemia & Lymphoma Society found exchange plans in several states that charged patients with blood cancer as much as 50% co-pay rates.

Cigna, Humana and CoventryOne said in separate statements that their plans follow the latest HHS guidelines, cover all medically necessary HIV drugs, and offer a variety of options so consumers can pick a plan that best meets their health needs. Preferred Medical did not immediately return a request for comment, Associated Press said. Insurance companies are increasingly sorting drug prices into a complex tier system and, in some cases, charging co-pay rates as high as 50%.

The ACA bans insurers from charging an individual more than $6,350 in out-of pocket costs a year or $12,700 for a family policy. But patients advocates warn those with serious illnesses could pay their entire out-of-pocket cap before their insurance kicks in any money.

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