In May 2014, the AIDS Institute and the National Health Law Program filed a complaint with the Office for Civil Rights at the U.S. Department of Health and Human Services (HHS OCR) accusing four health insurers, Cigna, Coventry One (part of Aetna Inc.), Humana Inc., and Preferred Medical Plan of unlawfully discriminating against people with HIV AIDS. The complaint alleged that by classifying all HIV/AIDS medications as “specialty drugs”, resulting in the patient being responsible for up to 40% of the price, these companies are violating the Affordable Care Act (ACA) and federal civil rights laws. The placement of all HIV/AIDS drugs on the “special tier” and the resultant increase in patient financial responsibility discourages people with HIV/AIDS from selecting their plans.
In a joint press release, the organizations indicated “The ACA provides robust consumer protections, including putting an end to discriminatory practices by health insurers,” said Wayne Turner, NHeLP staff attorney. “But these insurance plans are running afoul of that by placing all HIV/AIDS medications in the highest tiers with exorbitant co-insurance and co-pays, and instituting other barriers to obtaining commonly prescribed HIV/AIDS medications. The companies are going out of their way to discourage people with HIV/AIDS from enrolling in their plans—a blatantly illegal practice.”
“We want the Affordable Care Act (ACA) to work, and we want it to work for people living with HIV/AIDS and others with chronic health conditions,” said Carl Schmid, Deputy Executive, The AIDS Institute. “But shifting the cost of medications to the patients is not only blatant discrimination but can lead to poorer health outcomes, since beneficiaries will not be able to afford and access their life-saving medications.”
Cigna Corp., while not admitting any wrongdoing, agreed to restructure its HIV prescription drug benefits in its upcoming 2015 plans in Florida, making them less costly and burdensome for patients with HIV. Cigna will move the generic HIV drugs to a lower-cost generic tier, and also limit copays to $200 a month for each of the four other HIV drugs. Further, it will no longer require prior authorization for refills on these drugs.
Could this pave the way for other discrimination suits against insurance companies?.