Cigna Corp., a health insurer, has agreed in a settlement to reduce the cost of certain HIV drugs for patients in Florida under the state’s health care plan, reports The New York Times. Two advocacy groups, the National Health Law Program and the AIDS Institute, filed a lawsuit in May against four health insurance companies, including Cigna, claiming that the providers were discriminating against people with HIV and AIDS by making their medications unlawfully expensive. Cigna has agreed to a cap of $200 per month that patients would have to pay out-of-pocket for many commonly prescribed HIV drugs.
The lawsuit claimed that by placing HIV and AIDS medications—including generic brands—in a specialty pricing tier, insurers were discriminating against Floridians with pre-existing conditions, a practice made illegal by the Affordable Care Act. The specialty tiers of many marketplace health plans require patients to foot 40 to 50 percent of the drug’s cost on top of their deductible, which is often set at $1,000 or above. Many health plans in Florida also required a doctor’s advanced authorization to fill a specialty drug prescription or limited the prescription to a 30-day supply, according to The New York Times.
Cigna admitted no wrongdoing, but agreed in a consent order to lower generic HIV drugs to the generic tier, cap co-pays at $200 per month, and end authorization requirements for refills. The $200 limit will apply to only 2015 health insurance exchange plans, for which enrollment begins Nov. 15. The consent order affects the lawsuit filed with the advocacy groups, but does not affect a discrimination complaint the U.S. Department of Health and Human Services Office of Civil Rights filed against the company.
Health advocates say the discriminatory costs of HIV drugs are a way insurers like Cigna have been restructuring the formulary to reduce the number of patients with costly or pre-existing conditions who choose their company. Advocates claim there have been huge implications to the high costs of the drugs. According to CBS Miami, patients have skipped doses or foregone taking the medications entirely. Many of the drugs are part of a daily treatment and not taking them can cause serious health risks.
Alex Kepnes, a spokesman for another of the four insurance companies in the suit, mentioned that HIV drugs were not the only ones insurers placed on the higher payment tier. Medications for multiple sclerosis and rheumatoid arthritis are also found on the specialty tier. The AIDS Institute’s deputy director, Carl Schmid, said HIV drugs were being specifically targeted in the suit, because unlike the others, all HIV drugs were placed in the higher payment bracket, generic or not.
Schmid considers the consent order a step in the right direction, saying it was “big news” that the company had recognized the problem. Schmid also mentioned that the Office of Civil Rights is still conducting an investigation into the discrimination complaint. So far, Cigna is the only one of the four companies against which the lawsuit was filed that has agreed to lower the payment tier its generic HIV drugs fit in, reducing their cost.
By Sree Aatmaa Khalsa