Supporters of civil rights for people living in Florida with HIV/AIDS are
applauding the state Office of Insurance Regulation for warning insurance
companies not to overcharge patients for drugs in their 2016 federal
marketplace plans.
The notice, by Florida's Office of Insurance Regulation, follows complaints
last year by the Tampa-based AIDS Institute and National Health Law Program
claiming that four health insurance companies were illegally grouping up to 30
AIDS treatment drugs into the highest and most-expensive co-insurance payment
tier.
Florida's notice, sent to insurers in the spring, advised companies to be
ready to explain why their pricing of HIV/AIDS medications is not
"unfairly discriminatory" when they submit their 2016 health plan
rates for state review. Discriminatory pricing, the notice said, could result
in a recommendation for the plan's removal and decertification from the Federal
Health Insurance Marketplace.
"Florida's law is unique in that it specifically prohibits limiting
coverage for individuals with HIV or a specific medical condition resulting
from HIV such as AIDS," said Amy Bogner, spokeswoman for the Office of
Insurance Regulation, in an email.
Florida had 108,608 people living with HIV/AIDS at the end of April,
according to the state Department of Health. Of those, 26,678 were in Broward
and Palm Beach counties and 27,899 were in Miami-Dade.
According to the complaint filed with the federal Department of Health and
Human Services by the AIDS Institute and National Health Law Program in May
2014, four insurers – Aetna, Humana, Cigna and Preferred Medical -- were
placing drugs HIV and AIDS on high-percentage co-pay tiers that resulted in
some patients paying as much as $1,000 a month.
By making those drugs so expensive, the companies were discouraging people
with HIV/AIDS from enrolling in those plans and driving them to other plans
that limited co-pays for the drugs to $70 or less, said Carl Schmid, deputy
executive director of the AIDS Institute.
"I assume most patients went to other plans," Schmid said in an
interview. "That's what we didn't want to happen. That's not fair to those
plans" without the high co-pays.
The letter from Florida's insurance regulator to insurers outlined the
benchmark plan that limits patient co-pays to between $40 and $150 for a
month-long supply, except for an inject able drug with a $200 co-pay. A plan's
drug pricing formula will be considered compliant if it's at least "as
favorable as the state's benchmark plan," the letter to insurers stated.
In March, Aetna agreed to reduce co-pays for non-inject able drugs to no
more than $100 after deductibles are met. Previously, Cigna entered a consent
order with Florida regulators agreeing to move generic HIV drugs to a
lower-cost tier and cap co-payments for four other drugs at $200 a month in
2015.
Humana and Preferred Medical entered into similar agreements with the state
as well.
The AIDS Institute's Schmid said the Florida letter is important for two
reasons. One is the state's intention to review plans for how they price all
drugs, and not just HIV/AIDS drugs. Health plans are also charging high co-pays
for drugs that cover a number of chronic illnesses, including cancer,
rheumatoid arthritis and mental illness, he said.
Another reason is the letter cites the specific state law barring
discrimination against patients who need HIV/AIDS drugs.
Bogner, the Office of Insurance Regulation spokeswoman, said that state law
only protects discrimination against HIV/AIDS patients but that federal ACA
regulations require states to look at pricing of all classes of drugs.
"This is big news for Florida," Schmid said. "Good news for
anyone living with HIV in Florida and good news for anyone on medication in
Florida."
rhurtibise@sun-sentinel.com, 954-856-5364
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