Prescription Medication
Prescription pills in a plastic medicine bottle.
(Robert Byron)
Humana insurance plans on the marketplace in Alabama discriminated against patients with HIV by requiring high payments for expensive, lifesaving drugs, according to a complaint filed with the U.S. Department of Health and Human Services.
The complaint was one of seven lodged against insurers nationwide that either deny access to expensive drugs or require high out-of-pocket payments, according to a press release. AIDS Alabama teamed up with the Center for Health Law and Policy Innovation of Harvard Law School to bring the complaint against Humana.
Patients with HIV typically take several prescription drugs that suppress the virus and keep the disease from progressing. Before the development of drugs to treat HIV, the virus ravaged patients' immune systems, leaving them vulnerable to fatal infections.
Alex Smith, director of policy and advocacy for AIDS Alabama, said Humana placed all HIV and Hepatitis C drugs in a category that required patients to pay about half the cost of prescriptions. Low-cost generics aren't available for many of the drugs used to treat the virus, Smith said.
"For a lot of patients, that meant paying $1,700 out of pocket every month for drug costs," Smith said.
The Affordable Care Act prohibits insurers from discriminating against patients with chronic conditions, including charging them more for coverage or requiring higher co-payments. Smith said this is the first civil rights complaint filed about insurance cost-sharing practices that disproportionately affect people with HIV.
Humana denied discriminating against people with HIV and other chronic conditions in a statement about the complaint. Humana employees placed HIV drugs in the specialty drug tier based on the costs of the prescription, according to the statement.
"The specialty drug tier is limited to prescription drugs costing more than $600 per prescription," according to the statement. "Humana shares the concerns of HIV/AIDS organizations regarding the high cost of HIV/AIDS drugs and we are committed to working with them to mitigate pharmaceutical manufacturer pricing."
Humana and UnitedHealth will not offer individual plans in Alabama on the health insurance exchange next year. Only one insurance company, Blue Cross Blue Shield of Alabama, will offer individual plans in the state.
Smith said AIDS Alabama and Harvard Law School reviewed plans offered by Blue Cross and found a mixed bag. But he said the company's plans offered better access to prescription drugs than Humana plans.
"They are doing the right thing and pricing in a manner that gives patients fair access to drugs," he said.
Both Humana and UnitedHealth said financial losses on individual plans offered through the insurance exchange contributed to the decision to limit participation next year. The high cost of prescription drugs has driven some of the losses, according to the statement.
"Humana has made a commitment to providing individuals coverage through exchanges in 11 states for 2017 despite the well-documented challenges of the current individual insurance environment and the challenges of maintaining affordability of coverage in light of ever-escalating prescription drug costs - especially specialty drugs - which serves as one of the greatest drivers of increased cost," the statement said.