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Advocacy Groups Allege Discriminatory Pricing for HIV/AIDS Drugs

Advocacy Groups Allege Discriminatory Pricing for HIV/AIDS Drugs

June 2, 2014 — Two patient advocacy groups on Thursday filed a complaint with HHS' Office for Civil Rights, alleging that four health insurers are discriminating against customers with HIV/AIDS by requiring them to pay higher out-of-pocket costs for HIV/AIDS drugs, including generics, the New York Times reports (Thomas, New York Times, 5/29).

According to the Wall Street Journal, insurers are prohibited under the Affordable Care Act (PL 111-148) from charging certain consumers higher premiums because of medical conditions. However, HIV organizations believe that the four insurers -- Aetna subsidiary Coventry Health Care, Cigna, Humana and Preferred Medical Plan -- are sidestepping that requirement by charging such consumers more in other ways, such as through higher out-of-pocket costs for HIV drugs than for other prescription medications.

The complaint -- filed by the AIDS Institute and the National Health Law Program -- alleges that this strategy runs afoul of the ACA provision that bars insurers from discriminating against consumers based on "race, color, national origin, sex, age, or disability" (Radnofsky, Wall Street Journal, 5/29).

According to the complaint, the insurers discriminated against HIV/AIDS patients by restricting access to medications that most HIV/AIDS patients need to take daily to manage their health. Specifically, the advocacy groups allege that the insurers placed all available HIV drugs on the highest payment tier for silver-level plans sold through the federal health insurance marketplace in Florida (New York Times, 5/29).

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Wayne Turner, staff attorney for the National Health Law Program, said that if HHS' Office of Civil Rights does not take action, there could be "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" (Al-Faruque, The Hill, 5/29).

He added that the lawsuit appears to be the first to address insurers' benefit designs by using the ACA's antidiscrimination provision (Wall Street Journal, 5/29).

Meanwhile, representatives from all four insurers said that their plans' HIV drug coverage is in line with accepted medical practices and meets coverage requirements under the ACA (New York Times, 5/29).