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Investigation of Humana's Discriminatory HIV Drug Pricing Ends With a Fine and a Promise -- But Practice Continues With HCV Meds

February 23, 2016

Humana health insurance company has been fined $500,000 by Florida regulators for failing to cooperate with investigators looking into claims that its drug pricing discriminated against people living with HIV.

The Florida Office of Insurance Regulation (FIOR) announced the fine last week following an investigation into allegations that Humana and three other health insurers in Florida -- Cigna, Preferred Medical and CoventryOne -- structured their prescription drug policies to discourage people living with HIV from selecting their insurance plans.

The number of new HIV cases in Florida jumped 23% in the first six months of 2015. All six of the state's major metropolitan areas are on the U.S. Census Department's 2014 list of the top 25 cities with high HIV rates, with Miami sitting in first place.

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The complaint, lodged by The AIDS Institute and the National Health Law Program (NHeLP), alleged that the insurers placed all HIV drugs, including generics, on their highest (tier five) pricing schedule -- which in Humana's case required a 50% co-pay after a $1,500 deductible.

Discriminatory drug pricing would directly violate provisions of the Patient Protection and Affordable Care Act (Obama Care) and federal civil rights laws.

The FIOR said that Humana didn't make its documents "freely available" to investigators looking into these allegations as required by Florida law.

"The FOIR regulatory action sends a strong message that health insurers will be held accountable. Rigorous compliance monitoring and enforcement is essential to ensuring that the Affordable Care Act fulfills its promise of protecting patients against discrimination and providing affordable healthcare," NHeLP staff attorney Wayne Turner said in a joint press release from The AIDS Institute and NHeLP.

In the consent order issued by the state insurance commissioner, which ended the investigation into Humana's HIV drug pricing, Humana denied that its practices were discriminatory or violated the law, but agreed to pay the fine and "to maintain procedures to ensure that it does not by effect or design treat those living with HIV/AIDS less favorably than any other condition."

In the order Humana also agreed to establish an independent program -- not associated with its litigation department -- that would investigate and examine its market conduct.

In 2014, Humana entered into an agreement with the FIOR to lower 2015 federal marketplace plan co-pays on HIV medications from 50% to 10%. For medications costing less than $600, a $50 flat copayment fee would be charged.

While the pricing agreement and fine are a victory for Floridian's living with HIV, an AIDS Institute report has found that Florida insurance providers' discriminatory practices aren't limited to HIV medications.

According to the joint press release by The AIDS Institute and NHeLP:

The AIDS Institute's analysis of Florida's 2016 qualified health plans found that coverage for nearly all Hepatitis B and C drugs by several insurers remains subject to high co-insurance levels. Humana places almost all hepatitis C drugs on Tier 5, which translates into coinsurance of either a 40 or 50 percent of drug cost, after the patient pays a $3,800 deductible. Aetna and CoventryOne place all Hepatitis C drugs and almost all Hepatitis B drugs on Tiers 4 and 5, which carry coinsurance of 40 percent and 50 percent of drug cost, after a $2,750 deductible.

Althea Fung is the community editor for TheBody.com. For her thoughts on the health care industry, food and other random musing, check out her personal website, follow her on Twitter or stalk her on Facebook.


Copyright © 2016 Remedy Health Media, LLC. All rights reserved.


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