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Florida Affordable Care Act Insurers Accused of Discriminatory Practices Against HIV Patients

June 9, 2014

Sue Saltmarsh (Credit: Chris Knight)

Sue Saltmarsh (Credit: Chris Knight)

The AIDS Institute and the National Health Law Program (NHLP) filed a complaint with the U.S. Department of Health and Human Services (HHS)'s Office for Civil Rights on May 29 charging four insurers (CoventryOne, Cigna, Humana and Preferred Medical Plan) in Florida with violating the antidiscrimination provision of the Affordable Care Act (ACA), reported The New York Times. All four insurers have instituted restrictions on HIV drugs, and/or placed them on the highest payment "tier" of the midlevel "silver" exchange plans, causing patients' medication costs to skyrocket.

The AIDS Institute conducted an analysis of the prescription drug formularies and cost structure for all silver-level Qualified Health Plans (QHPs) operating in Florida. The analysis found that, of the 36 plans reviewed, the QHPs offered by the four companies charge inordinately high co-payments and coinsurance for HIV medications. According to the Times, all four companies claim that their HIV drug coverage is "in line with accepted medical practice and met requirements." However, other Florida insurers offer plans with reasonable co-pays, though a high deductible may also need to be met.

People living with HIV, as well as those with cancer, multiple sclerosis or other conditions that require expensive drugs to be taken regularly, may be forced to learn the unfortunate truth that coverage does not equal care. Practices such as these that result in driving HIV-positive people away from the most affordable plans -- known as "lemon dropping" -- are the insurance industry's answer to the provision of the ACA (or "Obamacare") that prohibits discrimination against people with preexisting conditions. Many people who purchased these plans are now facing higher out-of-pocket costs than they are able to pay -- deductibles starting at $1,000, as well as 40%-50% co-pays.

While this case pertains to the Florida exchange, similar practices have been reported elsewhere, including the 20 states (mostly in the South and the West) that have refused to expand Medicaid. According to Jennifer Kates, the director of global health and HIV policy at the Kaiser Family Foundation, this case will be watched closely, not only by the HIV community, but also by those living with other serious illnesses and their advocates. If the HHS sides with the HIV advocates, it would mean "this couldn't happen for those with diabetes or any other kind of condition."

Advocates have noted that all who shop for exchange policies, HIV positive or not, must take time to understand exactly what they're buying. Too often, shoppers look for the lowest monthly premium, not realizing that they may end up paying for insurance they can't use due to high deductibles, co-pays and coinsurance.

The Florida case reinforces that all who depend on adherence to a medication regimen to control their medical condition must also check the formulary of the plan they're considering to make sure their drugs are covered and to find out exactly how much they can expect to pay.

"We trust the Administration will take immediate action against these four insurance companies and send a strong message that this practice is illegal and discrimination against people with HIV/AIDS will not be tolerated," said Carl Schmid, the deputy executive director of The AIDS Institute, in a press release. "If they do not, other plans in Florida and across the country could adopt these very same discriminatory practices. This would make insurance coverage impossible for people with HIV/AIDS, and jeopardize their health and well-being."

Sue Saltmarsh has worked in the HIV/AIDS field for over 20 years, the first 10 as an herbalist and energy therapist at Project Vida, the last six as a writer and copy editor for Positively Aware magazine. She is now a freelance writer and editor and is also able to devote more time to her passion as founder and director of the Drive for Universal Healthcare (DUH).

Copyright © 2014 Remedy Health Media, LLC. All rights reserved.

This article was provided by TheBody.
See Also
More News on HIV and Health Insurance in Southern U.S. States

Reader Comments:

Comment by: W (Hartford, CT) Sun., Jun. 29, 2014 at 6:15 pm UTC
Part of the problem too is transparency. TRY researching the various plans on the public exchanges and it is buried/hidden/NOT disclosed.

Remember too that many of the drug manufacturers offer free copay cards that can help offset the financial burden.

Until our gov't attacks the drug industry and turns back their deal decades ago to gouge us while other countries pay close to nothing we will not have had effective healthcare reform nor anything to control ever spiraling costs.

Case in point - the new Gilead Hep C drug....treatment in the US = $84,000. The same treatment in Egypt is $800.

So President Obama, Reid and Pelosi - why not take THAT on.
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Comment by: Jeff (Florida) Fri., Jun. 20, 2014 at 9:42 pm UTC
Aetna did the exact same thing to me. after years of paying $100 copay for a 90 day supply of atripla they changed it from their preferred formulary list and increased my copay to over $1000. I filed a complaint through them and they said the decision to remove it from the preferred formulary list was based solely on medical and not financial reasons. Total bull.
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Comment by: Chuck (St Petersburg, FL) Thu., Jun. 19, 2014 at 7:54 pm UTC
This doesn't surprise me in the least. Florida, after all, is the state that scrapes the bottom of the barrel for just about everything. Anything having to do with the health and safety of it's citizens is completely ignored by the governor and the state legislature. Ripping off and stealing om your citizens seems to be the deed o the century for just about every elected official in this state. Which is why business gets away with so much and the citizens just get the shaft.
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Comment by: mike (austin) Thu., Jun. 19, 2014 at 7:54 pm UTC
Same challenges with Medicare Plan D. All HIV medications are in highest tier and it is going to cost me nearly $700/ month in retirement. Most likely I will opt for a shorter lifespan rather than live in poverty for my Lifetime. Thanks Republicans.
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Comment by: Matt (Miami) Tue., Jun. 10, 2014 at 2:59 pm UTC
They do the same thing with cancer drugs and other medications that are expensive so why would this be discriminatory. Our whole medical system is screwed up and especially drug pricing. We are the highest in the world. Friends in other countries cannot comprehend our ridiculous system. Even with Medicare, the Republican Congress refused to let the government negotiate drug prices so that they would be lowered for those with disabilities and seniors. Branded meds also are usually super high or not included at all...And Ive found many prescription copays to be HIGHER than the retail drug prices , which defeats the entire purpose of the insurance
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