Insurance Regulators To Cap HIV Drug Costs

Jun 29, 2015

Florida insurance regulators will start reviewing health plans for discriminatory practices after three insurers were accused of charging higher prices for HIV drugs.

Credit MGN Online

The Florida Office of Insurance Regulation announced it will review 2016 plans available on HealthCare.gov in Florida for possible discriminatory practices in their coverage of all prescription medications, and will also limit patient cost-sharing of HIV medications to reasonable co-pays.

Last year, the AIDS Institute and National Health Law Program filed a discrimination complaint over drug pricing with the U.S. Department of Health and Human Services Office for Civil Rights, against Cigna, Aetna, Humana and Preferred Medical.

“And that these insurance plans didn't want people with chronic conditions like HIV, which does cost money because these patients are on the drugs for the rest of their lives," said Carl Schmid, deputy executive director for the Tampa-based AIDS Institute.

The complaint accused Cigna, Humana, Preferred Medical and Aetna-owned CoventryOne of discriminating against patients with HIV.

"We found that some of the insurers put every single HIV drug- and there are 30 some odd drugs- on the highest tier and charged the patients co-insurance,” Schmid said.

That co-insurance, which the patient is responsible for paying, sometimes cost them more than $1,000 a month, he said.

"Why could Blue Cross (Florida Blue), why could United, why could Molina, why can they charge patients only $150 maximum? It's for the same drug,” Schmid said.

He said some of the providers, including Humana and Aetna, have already lowered their drug costs in response to the complaint, which is still pending.

In a memo sent to insurers preparing to file 2016 Marketplace plans, the OIR said it would deem plans as discriminatory if the tiered formulary of HIV/AIDS medications was not at least as favorable as the state’s benchmark plan.

Florida’s benchmark plan limits patient co-pays to $40, $70, or $150 per 30-day supply, depending on the medication.

One injectable medication has a co-pay of $200.  Plans in 2016 would have to limit patient cost-sharing for HIV and AIDS medications to levels that are similar to those in the benchmark.

“This is a major victory for people living with HIV who rely on medications to remain healthy,” Schmid said. “We thank the Florida Office of Insurance Regulation for recognizing that insurers charging excessive co-insurance is discrimination and harms people with HIV who cannot afford the cost of their medications.”

Daylina Miller is a reporter with WUSF in Tampa. WUSF is a part of Health News Florida, which receives support from the Corporation for Public Broadcasting.