Four Florida insurance companies are being evaluated by the federal government after complaints were filed against them by state health organizations for allegedly making the cost of drug policies too high for patients to afford.
CoventryOne, Cigna, Humana, and Preferred Medical insurance providers are accused of structuring their drug policies in a way that discourages individuals with HIV/AIDS from choosing plans with the companies. This policy creation is in violation of the Affordable Care Act (ACA), according to the National Health Law Program and The AIDS Institute, both of which filed a complaint Thursday with the Office for Civil Rights at the Department of Health and Human Services.
Though the complaints are still in the process of investigation, assertions against the four insurance companies claim they charge high up-front costs and require unwieldy prior authorizations. CoventryOne, for example, requires consumers to pay 40 percent co-insurance for the cost of all HIV drugs, including generics, after a $1,000 deductible, and the other plans have similar structures, requiring patients to pay 40 to 50 percent of the cost of their drug instead of the regular $10 co-pay.
“That would be about $1,000 per month per drug in most instances. What patient could afford that?” Carl Schmid, deputy executive director of The AIDS Institute, told AP.
If true, these figures should be alarming, especially to the South Florida area. According to health advocacy and health care provider Care Resource, based in Miami-Dade, the county ranks number one in the nation in logging the highest number of AIDS cases per capita in the United States; this disproportionately affects minorities such as Latinos and African-Americans.
Alex Kepnes, a spokesman for Humana, and Karen Eldred, a spokeswoman for Cigna, both noted to the Wall Street Journal that their company’s plans did cover HIV drugs.
According to Kepnes, Humana covered all HIV drugs except brand names when generics were available, and that the insurer considered most of them to be specialty drugs covered in the same category as treatments for conditions such as rheumatoid arthritis, multiple sclerosis and growth hormone disorders. This meant patients wouldn’t pay anything out-of-pocket until they had hit their maximum allotment for the year.
The Cigna representative also explained HIV drug coverage in more depth, indicating Cigna covered all HIV drugs that were recognized as “medically necessary” and also offered consumers with HIV support managing their condition from HIV specialists and medical professionals.
There is, of course, much leeway in the interpretation of drug plans, and health organizations say the four Florida companies are falling short of ACA compliance.
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South Florida attorney Vicki Tucci has been assisting more than 30 clients in their efforts to obtain HIV medications through Cigna, Humana, CoventryOne, and Preferred Medical, generally to no avail. She is currently working with advocacy groups to help find a way to cover costs of prescriptions.
“They go to the pharmacy and find their drug is not covered and they can’t afford them. There’s no way,” said Tucci.
If found to be in violation of the ACA, the four Florida insurance companies will be forced to change their policies and may suffer a fine or be responsible for reimbursement of costs to individuals currently on their plans.