Wednesday, November 22, 2017
Health

AIDS groups allege discrimination by four Florida insurers' Obamacare plans

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TAMPA — Advocacy groups accuse four Florida insurers of discriminating against patients with HIV and AIDS by overcharging them for their medications, including generics.

The AIDS Institute, based on Davis Islands, joined the National Health Law Program in a complaint against Cigna, Humana, Coventry Health Care and Preferred Medical.

The two groups found that the insurers' "silver" plans sold on the Obamacare exchange in Florida are designed so that routine medications for HIV/AIDS patients come with the greatest out-of-pocket costs.

Cigna, for instance, puts all HIV drugs, brand name and generic, in the highest "specialty drug" tier, requiring patients pay 40 percent of costs once they meet their deductibles, the complaint says. Similarly, Humana puts the drugs in a tier requiring patients pay 50 percent of their costs once they hit the deductible.

Some of the most popular HIV medications cost $2,400 to $2,948 for a 30-day supply. Most HIV patients take multiple drugs.

Though the Affordable Care Act sets maximum out-of-pocket limits at $6,350 for an individual and $12,700 for a family, an HIV patient can quickly hit those limits, noted Carl Schmid, deputy executive director in the AIDS Institute's Washington office.

The complaint, which was filed with the U.S. Department of Health and Human Services' Office of Civil Rights, asks federal officials to review the plans and force the four insurers to change their benefits.

The complaint also notes that other insurers charge much less for HIV medications. Florida Blue's plans, for instance, put most HIV drugs in the lowest two tiers, which require co-payments ranging from $10 to $70.

Because these insurers did not put HIV in high-cost specialty tiers, Schmid says advocates can prove that the four insurers named in the complaint are trying to keep expensive HIV patients out of their plans.

Humana, Coventry and Cigna said in statements that they cover all the necessary HIV drugs, and that there are multiple plans from which to choose, including some with higher premiums but lower cost-sharing requirements.

Humana also noted that drugs for other conditions, such as rheumatoid arthritis and multiple sclerosis, are also on highest payment tier. Preferred Medical, based in Coral Gables, did not return a phone message seeking comment.

Wayne Turner, staff lawyer with the National Health Law Program, said he fears that other insurers may follow the leads of the four named in the complaint.

"If health plans are allowed to structure their benefits in such a way that discourages HIV/AIDS patients from enrolling, it'll have a race-to-the-bottom effect," he said. "That's a scary situation, and it's contrary to what the Affordable Care Act is all about."

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

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