Cover Story

GREED: Humana Overcharges for HIV Drugs–Again

Written by Richard Hack

A year and a half ago, on December 15, 2014, the president of HumanaOne, Steve DeRaleau, reached an agreement with the Florida Office of Insurance Regulation. The third largest health insurance company in the United States had been charged with violating section 641.3007, Florida Statutes which states that “A health maintenance organization may not discriminate against an individual who has HIV/AIDS by excluding or limiting coverage.”

Humana had placed all prescription drugs used in the treatment of HIV/AIDS in a specialty tier which placed their cost out of reach of most patients struggling with the effects of the disease. Florida officials began investigating after two advocacy groups — the AIDS Institute based on Davis Islands in Tampa and the National Health Law Program — filed a federal complaint alleging four insurance companies had discriminated against HIV and AIDS patients.

The insurers named in the complaint were Cigna, Humana, Coventry Health Care and Preferred Medical.

The agreement that DeRaleau signed with the state of Florida guaranteed that Humana with limit the “subscriber’s cost-sharing responsibility for all HIV/AIDS drugs…to 10% of the cost of the prescription drug,” while also denying that Human “unfairly discriminates” against those with HIV.

While sources says that Humana began to honor its commitment to the state during 2015, new evidence obtained by the Florida Agenda shows that the company is abandoning its pledge, as witnessed by recent receipts obtained from Publix pharmacy—a Humana authorized drug dispensary.

Truvada is the most popular drug used to prevent HIV cells from multiplying in the body. It is also frequently used as a pre-exposure prophylaxis to keep negative individuals from acquiring the disease. The nucleoside analog reverse transcriptase inhibitor combines antiviral drugs emtricitabine and tenofovir. The usual and customary cost of the drug is $1,834.95 for a month’s supply of 30 pills.

Under Humana’s signed agreement, those pills should cost a subscriber no more than $183 per month—already quite a burden considering that Truvada is not taken alone, but in combination with another drug like Isentress.

Isentress, or its generic form raltegravir, costs an additional $1610.95 for a month’s supply and helps support Truvada in keeping the virus from duplicating. According to the agreement, Isentress should cost the subscriber no more than $161, or a total of $344 for the complete monthly treatment.

As the Publix receipts prove, this Humana subscriber was charged a total of $950.99—nearly three times the co-pay that the insurer guaranteed it would charge. Given the current state of HIV treatment, these drugs need to be taken for life.

Calls placed for comment to Nancy A. Hanewinckel, Media relations manager for Humana in South Florida, were not returned.

The National Health Law Program is reinvestigating the charges against Humana, which will result in a new complaint to the Federal Department of Health and Human Services as well as Florida’s Office of Insurance Regulation.

“Florida’s law is unique in that it specifically prohibits limiting coverage for individuals with HIV or a specific medical condition resulting from HIV such as AIDS,” Amy Bogner, spokeswoman for the Office of Insurance Regulation, said in an email.

Florida had 108,608 people living with HIV/AIDS at the end of April 2015, according to the state Department of Health. Of those, 26,678 were in Broward and Palm Beach counties and 27,899 were in Miami-Dade.

Meanwhile Humana, which is in the process of being acquired by Aetna, had gross revenue of $41 billion.

UPDATE: On February 16, 2016, Humana agreed to pay a fine of $500,000 in penalties in relation to the 2014 investigation by the Office of Insurance Regulation that the insurer may have been in violation of Florida’s HIV/AIDS anti-discrimination law. According to the Consent Order released by OIR commissioner Kevin M. McCarty, Humana will also pay $3,000 in administrative costs.

As part of the Consent order, Humana has promised to establish an independent market conduct examination and investigation compliance program no later than July 1, 2016.

For its part, Humana continues to deny allegations that its classification of drugs unfailrly discriminated or that is plan violated the Florida Insurance code.

The consent order does not address the current pricing of HIV drugs which appear to be in directly violation of its agreed upon commitment to the Florida Office of Insurance Regulation.