Insurers Accused Of HIV Bias

Two HIV advocacy groups filed a federal complaint yesterday over four insurance companies that have placed anti-retroviral medications in their highest payment tiers. Via the New York Times:

The complaint asserts that the four insurers — CoventryOne, Cigna, Humana and Preferred Medical Plan — placed H.I.V. drugs on the highest payment tier for midlevel, or silver, plans on the federal health insurance exchange in Florida. CoventryOne, for example, placed every H.I.V. drug, including generics, on the most restrictive tier, which meant consumers were required to exhaust a $1,000 deductible and were then asked to contribute 40 percent toward the cost of their drugs, the groups said. Similarly, Humana requires that members spend their $1,500 deductible and then contribute 50 percent, they said. Many of the plans, the groups said, also placed other requirements on the drugs, like advance authorization by a doctor or a limit of a 30-day supply. Representatives for all four insurers said their plans’ H.I.V. drug coverage was in line with accepted medical practice and met requirements for coverage.

More from the Wall Street Journal: 

HIV advocacy organizations have said the issue isn’t specific to Florida and they believe a decision would influence plans across the country. The health law bars insurers from charging customers more based on their medical history when it comes to setting premiums. The Wall Street Journal reported in December that HIV organizations believed some health insurers had found other ways to discourage people infected with HIV from signing up for their plans, such as requiring higher copayments for HIV drugs than they would for other prescriptions. The two patient advocacy organizations are trying to challenge that practice by using another provision in the health law that bars any health program that receives federal funds from discriminating on the basis of “race, color, national origin, sex, age, or disability.”