‘Obamacare’ Giving Loophole to Insurance Companies on HIV Medications in Florida

The Affordable Care Act was supposed to help AIDS patients, but four Florida health insurance providers are doing just the opposite, health agencies say.

Pharmaceutical Research and Manufacturers of America (PHRMA) commissioned a study of healthcare plans available through the ACA, finding that up to 35 percent of them placed AIDS/HIV medications — even generic ones — in the highest price bracket, level five.

In Florida, four insurance companies are doing this: Cigna, Humana, CoventryOne, and Affordable Health.

“What the plans here seem to be doing is designing their benefits to discourage patients with HIV/AIDS from enrolling in their plans,” said Wayne Turner, staff attorney with the National Health Law Program.

With the creation of the ACA, also known as Obamacare, insurance companies could no longer turn down a client because of their preexisting conditions. Patients spending thousands of dollars a month on HIV/AIDS medications were one group of many that were relieved by this. However, the insurance companies are alleged to have found a way around this.

While generic drugs tend to go on lower pricing tiers, and specialty drugs in higher tiers, there is no hard and fast rule on what constitutes a specialty drug. Insurance companies can choose to place whatever medications on whatever tier they want.

“Health plans don’t want to be the best health plan for HIV and AIDS because people with HIV and AIDS have prescription drugs and other health needs,” Turner said. “That’s not the point of the Affordable Care Act.”

It’s also not allowed — the act prohibits “discriminatory health insurance practices,” according to the complaint the National Health Law Program and The AIDS Institute filed with the Office of Civil Rights in May.

In a statement to South Florida Gay News from Humana, the AIDS/HIV medications are in the same category as those for rheumatoid arthritis, multiple sclerosis, hepatitis B & C, cancer, growth hormone disorders, anemia, osteoporosis, and Idiopathic thrombocytopenic purpura.

“Humana offers several plan choices so members can select the one that best meets their needs and budget,” according to the statement.

A representative from Cigna said the company doesn’t comment on pending legal issues, but noted that, “Cigna plans provide access to HIV care and prescription drugs that not only follow the latest HHS guidelines and evidence-based practices, but also provide comprehensive customer support through a dedicated condition-specific team consisting of nurses, pharmacists and therapy support coordinators. The plans include coverage for all medically necessary HIV drugs.”

According to the study from PHRMA, putting medications on higher tiers requires the patient to foot at least 40 percent of the cost. Taking into account the cost of monthly premiums, doctor visits, tests, and other health-related procedures, costs add up quickly.

“Shifting the cost of medications to patients, by some plans, is not only blatant discrimination, but it can lead to poorer health outcomes since beneficiaries will not be able to afford and access their life-saving medications,” Carl Schmid, deputy executive director of The AIDS Institute, said in a statement from PHRMA.

And it does have an impact on HIV/AIDS patients: only 17 percent of people living with HIV have private insurance, according to the Centers for Disease Control and Prevention. About 30 percent don’t have any form of insurance.

Have you experienced discrimination from your health insurance company? We want to hear about it!


Originally published in South Florida Gay News.

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