Cambridge, MA – A Harvard University healthcare advocacy group recently filed complaints against seven health insurers in eight states, claiming that they discriminate against HIV patients by making vital medications they need either too expensive or by not covering the drugs at all, according to Kaiser Health News.
The complaint was filed in September by the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) with the Department of Health and Human Services’ Office of Civil Rights (OCR).
CHIPL argues that plans by Anthem Blue Cross Blue Shield, Cigna, Community Health Choice, Highmark, Humana, Independence Blue Cross, and UPMC Health Plan, in Alabama, Georgia, Illinois, Louisiana, Pennsylvania, Tennessee, Texas and Wisconsin, circumvent federal health care law, which profits insures from discriminating against people based on medical condition.
The result not only renders essential treatments unaffordable and unavailable for people living with HIV in those states, it’s alleged to violate both their health care rights guaranteed under the Affordable Health Care (ACA) and their civil rights protections under the Americans with Disabilities Act (ADA).
“What’s most important to us is that there’s a robust enforcement mechanism around the promises … in the ACA and its regulations, especially the anti-discrimination provisions,” said Kevin Costello, director of litigation at CHLPI.
The Harvard center, along with AIDS groups in seven states, examined silver-level–plans, where insurance companies pay 70%, and patients pay 30% and have lower out-of-pocket premiums–available on the Marketplace, to determine whether the plans cover six treatment regimens that are the current standards of care for treating HIV.
CHIPL says the insurers bypass the ACA and its regulations by refusing to cover single-tablet drug regimens that are often tied to better compliance because a number of effective medicines are combined in one pill. Alternatively, the insurers place most or all of the drugs in the higher gold and premium cost tiers, with patients having to shell out higher monthly premiums, according to the complaint.
CHIPL found, for example, that Anthem silver plans in Wisconsin cover only four of the 16 drugs or combination products that are recommended to meet the current standard of care, and they fail to cover any single-tablet regimens. In Illinois, the center charged that Humana’s silver plans place 16 of the 24 most commonly prescribed HIV drugs in the highest cost-sharing tier, which requires patients to pay 50 percent of the cost.
With estimated monthly costs ranging from $377 to $684 for different drug regimens, enrollees in the Illinois Humana plans would have to pony up between 8 and 14 percent of their average monthly income, according to the Harvard center.
Costello said although the complaints are addressing HIV drugs, the center hopes the complaint speaks to the larger issue of patients with chronic illnesses difficulty in accessing drugs.