Federal Complaint Says Ga. Insurers Overcharge For HIV Meds

http://news.wabe.org/post/federal-complaint-says-ga-insurers-overcharge-hiv-meds

Public health researchers say health insurers Cigna and Humana are overcharging for HIV treatments. Both companies offer plans under Georgia’s Affordable Care Act exchange.

Doctor Melanie Thompson is with the AIDS Research Consortium of Atlanta, which, along with Harvard’s Center for Health Law and Policy Innovation, filed federal discrimination complaints against the companies after looking into their HIV medication coverage in 2014 and 2015.

“Initially people were so happy to have health insurance, and they went to the pharmacy and came back and said, ‘Wow, they told me I have to pay $800 cash and I just don’t have it.’ So they were out of their drugs,” said Thompson.

She said the risks for patients are huge if they miss HIV treatments, to say nothing of the potential impact on public health.

“People with HIV require a continuous supply of medication. They have to keep the virus suppressed at all times, otherwise the virus can become resistant to drugs and the drugs can stop working,” said Thompson, who added that without suppression, the virus can once again be transmitted to others.

In some cases, Thompson said Atlantans living with HIV are paying up to 40 percent of their income to keep up treatments.

“Most insurers were able to manage these medications in a way that was somewhat affordable, but Cigna and Humana plans really stood out,” Thompson said.

Researchers found that the insurers classified federally recommended HIV medications as belonging to the highest cost-sharing categories, something other companies have managed to avoid doing by offering plans with flat co-pays rather than requiring patients to pay a proportion of these very high-cost treatments.

Discrimination in health care is illegal as a result of the Affordable Care Act. Thompson said they filed complaints with the US Department of Health and Human Services Office of Civil Rights because their analysis proves that people with HIV are being treated differently.

Georgia is one of seven states being impacted by insurers with expensive HIV medication plans. Local advocacy groups have filed similar federal complaints on behalf of people living with HIV in their own states.

Thompson said she’s hopeful the complaints alone are enough to change the insurers’ behavior. She added that some patients may not even realize there are alternatives to the amounts they’re paying.

“People don’t understand the insurance industry to begin with,” Thompson said. “They don’t know how to analyze these plans. It’s not really easy to see that one insurance company treats their drug in a different way.”

In a statement, Humana said their plans comply with federal regulations, and that they will work with HIV/AIDS advocates to mitigate the growing costs of the medications. Humana claims high drug costs have forced them to pass along the expense.

Cigna declined to comment. 

Filed under: General Problems