Insurers Discriminating Against HIV/AIDS Patients, Groups Allege
On Thursday, two patient advocacy groups filed a complaint with HHS' Office for Civil Rights, alleging that four health insurers are discriminating against customers with HIV/AIDS by requiring them to pay higher out-of-pocket costs for HIV/AIDS drugs, including generics, the New York Times reports (Thomas, New York Times, 5/29).
According to the Wall Street Journal, insurers are prohibited under the Affordable Care Act from charging certain consumers higher premiums because of medical conditions. However, HIV organizations believe that the four insurers -- Aetna subsidiary CoventryOne, Cigna, Humana and Preferred Medical Plan -- are sidestepping that requirement by charging such consumers more in other ways, such as through higher out-of-pocket costs for HIV drugs than for other prescription medications.
The complaint -- filed by the AIDS Institute and the National Health Law Program -- alleges that strategy runs afoul of the ACA provision that bars insurers from discriminating against consumers based on "race, color, national origin, sex, age or disability" (Radnofsky, Wall Street Journal, 5/29).
According to the complaint, the insurers discriminated against HIV/AIDS patients by restricting access to medications that most HIV/AIDS patients need to take daily to manage their health. Specifically, the advocacy groups allege that the insurers placed all available HIV drugs on the highest payment tier for silver-level plans sold through the federal health insurance exchange in Florida.
The lawsuit cites several examples, including how:
- CoventryOne placed all HIV drugs, including generics, on the most restrictive tier, which meant that consumers had to first pay a $1,000 deductible and then contribute 40% toward the cost of the medications;
- Humana required its customers to reach a $1,500 deductible and then contribute 50% toward the cost of the medications; and
- Several of the plans also placed additional restrictions on the drugs, such as advance authorization requirements or 30-day supply limits.
The advocacy groups argue that the situation is discriminatory because not all insurers had such across-the-board restrictions on HIV/AIDS drugs, unlike specialty drugs for diabetes and other conditions (New York Times, 5/29).
Wayne Turner, staff attorney for the National Health Law Program, said that if the groups "don't see action by [HHS'] Office for Civil Rights, what [they] may be seeing is a race to the bottom in which health plans not only in Florida but across the country will mark up their AIDS drugs to discourage people with HIV from enrolling" (Al-Faruque, The Hill, 5/29).
He added that the lawsuit appears to be the first to address insurers' benefit designs by using the ACA's antidiscrimination provision (Wall Street Journal, 5/29).
Separately, AIDS Institute Deputy Executive Director Carl Schmid said that such restrictions and high costs could result in serious health concerns, such as missed doses and coverage gaps. He also said that the practice, if allowed to stand, could spread to other insurers, adding, "We want the ACA to work, and it won't work for people with HIV if plans are designed this way" (The Hill, 5/29).
Meanwhile, representatives from all four insurers said that their plans' HIV drug coverage is in line with accepted medical practices and meets coverage requirements under the ACA (New York Times, 5/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.