The National Health Law Program and the AIDS Institute said in the complaint that CoventryOne, Cigna, Humana and Preferred Medical have all structured their plans so costs for HIV and AIDS medications are so high that customers with the disease will be discouraged from choosing them as their insurer. They allege that these companies are violating section 1557 of the Affordable Care Act, which prohibits insurance companies from discriminating against customers on the basis of disability.
The 36 plans offered in the Marketplace and reviewed by patient advocacy groups show that the companies placed all HIV/AIDS medications on Tier 5 with co-pays as high as 50 percent and deductibles up to $2,750, with several requiring prior authorization.
"What is unique here is that it's every single drug, no matter whether it is generic or not," said Carl Schmid, deputy executive director of the AIDS Institute. "Other plans don't do this for HIV, and that's why we're proving that it's discrimination."
Cigna spokeswoman Karen Eldred said that their company, like others, offers an array of plans and some include more comprehensive coverage. She added they covered all HIV drugs deemed medically necessary.
Alex Kepnes, a spokesman for Humana, said that they cover all HIV medications except brand names when there is an acceptable generic alternative. He also noted that customers would not have to pay anything when filling their prescriptions once they hit their maximum on out-of-pocket costs. Under the ACA, plans cannot have out-of-pocket costs higher than $6,350 for 2014.
This is part of a trend where insurers are asking people to pay more for specialty drugs in an effort to keep premiums low. In addition to HIV patients, people with serious conditions, like cancer or rheumatoid arthritis, are seeing their drug costs soar.