ObamaCare insurers accused of overcharging for HIV/AIDS drugs

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Advocacy groups are accusing four health insurers in Florida of violating federal ObamaCare rules by discriminating against people with HIV and AIDS.

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The National Health Law Program and The AIDS Institute have filed a complaint against CoventryOne, Cigna, Humana and Preferred Medical in Florida with the Office of Civil Rights at the Department of Health and Human Services alleging that their ObamaCare plans are overcharging for treatments.

According to the advocacy groups, analysis of prescription drug formularies and cost structure for all silver-level Qualified Health Plans in Florida — one of the options under ObamaCare — found the four insurance providers charged inordinately high copayments and co-insurance for drugs used to treat HIV and AIDS.

They say the way drug pricing is structured, people with HIV and AIDS would have to pay more than $1,000 a month for their treatments. Some plans are also requiring prior authorization or approval by the plan for HIV drugs, the groups allege.

“When you put up roadblocks to assessing life saving medications through these high out of pocket costs and prior authorizations people with HIV are more likely to miss doses, experience gaps in treatment and go off treatment altogether,” said Carl Schmid, deputy executive director at The AIDS Institute. “As a result patients can develop drug resistance, become sick and even die.”

Wayne Turner, an attorney with the health law group, said the four insurers mentioned in the complaint “run afoul” of the Affordable Care Act’s (ACA) nondiscriminatory provisions and said the government must take a stand.

“If we don’t see action by the Department of Health and Human Services’ Office of Civil Rights what we may be seeing is a race to the bottom in which health plans not only in Florida but across the country will mark up their AIDS drugs to discourage people with HIV from enrolling,” Turner said.

He said insurers that are found to violate the ACA should be fined and their plans should be removed from the ObamaCare marketplace.

Schmid says the problem isn’t limited to Florida and they are seeing the same kinds of behavior from insurers in states such as Illinois.

“We’re concerned if these plans are not found to be discriminatory we feel that other plans inside the exchanges and outside the exchanges will develop the same kinds of practices and will make it really impossible for people with HIV and other chronic conditions to access medications and healthcare reforms,” he added. “We want the ACA to work and it won’t work for people with HIV if plans are designed this way.”

The advocacy groups say unlike CoventryOne, Cigna, Humana and Preferred Medical other insurers such as Blue Cross, Ambetter and Molina have designed their plans in a way that was better at cost sharing for people with HIV and AIDS.

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