Advocates for people with HIV and AIDS charged that insurers including Aetna Inc. (AET), Humana Inc. (HUM) and Cigna Corp. (CI) have discriminated against Obamacare patients in Florida infected with the virus.
The Tampa-based AIDS Institute and the National Health Law Program, an advocacy group in Washington, filed a complaint with the U.S. Health and Human Services Department alleging that the insurers tried to steer HIV and AIDS patients away from plans offered in the federal insurance exchange in Florida by restricting coverage of medicines for the disease. In mid-level “silver plans” offered in Florida, all three insurers require high out-of-pocket spending before covering any HIV/AIDS drugs, even generic ones, the groups said.
The Patient Protection and Affordable Care Act for the first time prohibits insurers from refusing coverage to people who are sick. Advocates of people with illnesses requiring costly treatment, such as AIDS or cancer, have been concerned that insurers would construct benefit packages discouraging sick people from selecting their products.
The Obama administration should “take immediate action” and “send a strong message that this practice is illegal and discrimination against people with HIV/AIDS will not be tolerated,” Carl Schmid, deputy executive director of The AIDS Institute, said in a statement.
Silver plans offered in Florida by Humana, Cigna, Aetna’s Coventry brand and a fourth company, closely held Preferred Medical Plan, placed all HIV medicines including generics into the fifth tier of their drug formularies, which require the highest out-of-pocket spending before coverage kicks in, the AIDS groups said in a complaint filed with the HHS Office of Civil Rights.
The plans require patients to pay deductibles of as much as $2,750 plus as much as 50 percent of the cost of any drug in the fifth tier, called co-insurance, the complaint said. The fifth tiers of drug formularies are usually reserved for very high-cost drugs called specialty medicines.
Spokesmen for Aetna, Humana and Cigna said their plans complied with the health-care law and with Obama administration regulations, and noted that the law provides a cap on what any exchange customer has to pay out-of-pocket. This year, that cap is $6,350 per year for an individual, although in some plans it may be separately applied to drug and medical coverage.
“Humana offers several plan choices so members can select the one that best meets their needs and budget,” Alex Kepnes, a spokesman for the Louisville, Kentucky-based company, said in an e-mail. “Once the out-of-pocket maximum is reached for the year, the plan pays 100 percent of the cost for any drug therapy, including HIV drugs.”
Other insurers on Florida’s exchange offer more generous coverage of HIV medicines, according to the complaint. Florida Blue Cross, for example, “places most HIV drugs on either tier 1 or tier 2,” requiring a co-payment of $10 to $70, according to the complaint.
Plans that Aetna offers under its own brand, rather than Coventry’s, place generic versions of several HIV drugs in tier 1 of its formularies.
“The exchange plans offered by Coventry provide access to HIV care that follows the latest Department of Health and Human Services guidelines and evidence-based practices,” Cynthia Michener, an spokeswoman for Hartford, Connecticut-based Aetna said in an e-mail. “The Coventry formularies meet ACA requirements and provide access to drugs necessary for treatment under the current clinical guidelines.”
Karen Eldred, a spokeswoman for Bloomfield, Connecticut-based Cigna, said the company’s plans cover all “medically necessary HIV drugs” and also provide patients access to a “dedicated condition-specific team” of health professionals to advise them on their care.
“There are plans that offer the flexibility of a higher deductible and lower monthly premium and those that have higher premiums and lower cost sharing for greater predictability,” she said in an e-mail.
A phone message left with Preferred Medical of Coral Cables, Florida, wasn’t immediately returned.
To contact the editors responsible for this story: Reg Gale at firstname.lastname@example.org Andrew Pollack, Bruce Rule