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Humana, Cigna among insurers facing complaints over alleged HIV drug coverage discrimination — 9 insights

Cambridge, Mass.-based Harvard Law School's Center for Health Law and Policy Innovation filed complaints with HHS' Office for Civil Rights against seven insurers in eight states for allegedly engaging in discriminatory drug coverage practices, according to Healthcare Finance.

In the complaints, Harvard Law School named Humana plans in six states (Alabama, Georgia, Illinois, Louisiana, Tennessee and Texas) as well as Cigna plans in three states (Georgia, Tennessee and Texas). Other payers Harvard Law School named include Highmark, Independence Blue Cross and UPMC health plan, all in Pennsylvania as well as a complaint against Community Health Choice in Texas and a complaint against Anthem Blue Cross Blue Shield in Wisconsin.

Here are nine insights:

1. The complaints claim the payers don't cover drugs that are necessary to treat HIV, or require patients to pay escalated out-of-pocket costs. Federal legislation bans marketplace plans from implementing benefit designs that discriminate based on age, illness, race, gender or sexual orientation, among other things, but federal regulators do not define discriminatory plan design. Rather, they say they will assess the facts on a case-by-case basis.

2.  Regulators do say, however, "potentially discriminatory practices" may include plans that do not cover a single-tablet drug regiment, which are often tied to better compliance. Potentially discriminatory practices may also include putting "most or all of the drugs that treat a specific condition in the highest cost tiers."

3. The Harvard center teamed up with local AIDs groups in various states and looked at silver-level plans sold on the marketplaces, assessing whether their formularies would allow access to six treatment regimens that are the current standard of care for treating people who are newly diagnosed with HIV.

4. They found of the Anthem silver plans in Wisconsin, the plans only cover four of the 16 drugs or combination products that are recommended to meet the current standard of care. The plans also do not cover any single-tablet drug regiments.

5. Anthem Public Relations Director Scott Larrivee said, "Anthem BCBS is committed to providing all of our members with access to the care and services they need, including appropriate coverage of medications for the treatment of HIV/AIDS..."

6. The center also found Humana silver plans in Illinois put 16 of the 24 most commonly prescribed HIV drugs in the highest cost-sharing tier. These plans mandate patients pay 50 percent of that cost.  

7. Alex Kepnes, Humana's director of corporate communications, said all the payer's plans on the marketplace comply with state and federal laws. He said, "Humana shares the concerns of HIV/AIDS organizations regarding the high cost of HIV/AIDS drugs and we are committed to working with them to lower prescription drug costs."

8. A Cigna spokesperson said the company does not comment on pending legal matters.

9. Kevin Costello, director of litigation at Harvard Law School's Center for Health Law and Policy Innovation, 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.

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