FORT LAUDERDALE, Fla. — Two health organizations filed a complaint with federal officials Thursday, alleging that some Florida insurance companies are violating the Affordable Care Act by structuring their drug policies in a way that discourages consumers with HIV and AIDS from choosing their plans.
The National Health Law Program and The AIDS Institute say four insurance companies offering plans in Florida through the federal online exchange required HIV and AIDS patients to pay a percentage of their often expensive drugs instead of a flat co-pay. For example, instead of paying a flat $10 co-pay at the pharmacy, the plans require patients to pay 40 to 50 percent of the cost of their drug, which could run into the thousands of dollars.
The report alleges that CoventryOne requires consumers to pay 40 percent co-insurance for the cost of all HIV drugs, including generics, after a $1,000 deductible.
“That would be about $1,000 per month pe r drug in most instances. What patient could afford that?” said Carl Schmid, deputy executive director of The AIDS Institute.
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Health advocates warn high costs cause patients to skip doses or go off their medications altogether, causing serious health complications.
The complaint, which also alleges the plans charged high up-front costs and unwieldy prior authorization requirements, asks the Office for Civil Rights at the Department of Health and Human Services to investigate the Florida plans offered by CoventryOne, Cigna, Humana and Preferred Medical and to require insurance companies to take corrective actions if necessary.
Cigna, Humana and Coventry said in separate statements that their plans follow the latest HHS guidelines, cover all medically necessary HIV drugs and offer a variety of options so consumers can pick a plan that best meets their health needs. Preferred Medical did not immediately return a call seeking comment.
Insurance companies are increasingly sorting drug prices into a complex tier system and, in some cases, charging co-insurance rates as high as 50 percent. Even before the Affordable Care Act took effect, insurers had increasingly begun requiring patients to pay a percentage of the drug costs instead of a flat co-pay, but experts say patients often spend more for their prescriptions in plans offered under the health law because of the co-insurance.
The organizations did not know how many HIV and AIDS patients had purchased health plans from companies being targeted in the complaint. But a study from the nonpartisan Kaiser Family Foundation estimates about 23,000 uninsured people in the U.S. being treated for HIV and AIDS would be eligible for coverage through the online exchange.
Although the complaint filed Thursday specifically addresses HIV and AIDS, other health advocates have expressed concerns about high co-insurance for others with serious illnesses, including cancer and rheu matoid arthritis, that require expensive drugs.
The Leukemia & Lymphoma Society found exchange plans in several states that charged patients with blood cancer as much as 50 percent co-insurance rates. The National Multiple Sclerosis Society recently addressed the issue at a conference in Washington.
Health advocates are also quick to point out that before the Affordable Care Act, many of their patients struggled to have health insurance at all. The law forbids insurers from discriminating against those with pre-existing conditions.
The law also bans insurers from charging an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy. But patients advocates warn those with serious illnesses could pay their entire out-of-pocket cap before their insurance kicks in any money.
Health advocates worry the real impacts will be felt in future years if federal health officials don’t step in.
“Plans do not wa nt to be the preferred plan for people with HIV and AIDS. They do not want that reputation … plans are going to be restructuring their benefit redesign and emulating what these bad actors have demonstrated,” said Wayne Turner, attorney for The National Health Law Program.
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