MIAMI—HIV patients who rely on state-run health programs for their lifesaving medications have been informed that they must switch to federally run insurance exchange or the state will state paying for drugs.
“The landscape of healthcare has changed, and with the passage of the Affordable Care Act we have the opportunity to access and enroll in cost-effective health plans,” an official at the AIDS Insurance Continuation Program wrote in a letter to AICP beneficiaries.
Yet, according to patient advocates, it is not clear that the ACA insurance plans will be cheaper — or even affordable — for those with HIV and AIDS
Last yeaar, the AIDS Institute and the National Health Law Program filed a federal civil rights complaint alleging that some Florida insurers were discriminating against people with HIV by charging “inordinately high” rates for HIV medication on ACA plans.
In their complaint, the non-profit groups charged that CoventryOne, Cigna, Humana and Preferred Medical were discouraging people with HIV “from enrolling in those health plans — a practice which unlawfully discriminates on the basis of disability.”
The ACA prohibits insurers from discriminating against consumers because of preexisting medical conditions. The four companies all offered 2014 plans in Florida, including in Miami-Dade and Broward counties, and plan to do so again in 2015, with the exception of Preferred Medical in Broward, according to the Miami Herald.
Florida has the third-highest rate of HIV infection in the nation, with Broward and Miami-Dade counties having the highest rates statewide. Almost 95,000 people in Florida have been diagnosed with HIV. Many of them have coverage for the first time thanks to the health law, activists say. But without proper regulation, high drug prices could act as a de facto form of discrimination, said Carl Schmid, deputy executive director of the Tampa-based AIDS Institute, one of the groups that filed the civil rights complaint.
In a statement to the Miami Herald last week, Coventry spokesman Walt Cherniak said the insurer’s 2014 plans provided access to HIV care “that follows the latest Department of Health and Human Services guidelines and evidence-based practices.” Humana, Preferred Medical and Cigna also issued statements to the Herald denying any discrimination. Humana said it places HIV drugs on its highest — and most expensive — tier because of their cost and clinical complexity.
Unfortunately, the details of 2015 insurance plans on the federal exchange in Florida will not be announced until early November when open enrollment begins.
HHS said the complaint, filed in May, is still under review by its Office for Civil Rights, which protects consumers from discrimination. The complaint asked the OCR to prevent the four companies from offering plans with discriminatory costs.
Harvey Bennett, a spokesman for the Florida Office of Insurance Regulation, said the state was also investigating whether the plans were “unfairly discriminatory.”
Fortunately, not all insurers on the exchange are being accused of discrimination. Aetna, Ambetter and Molina placed most of their HIV drugs on less-expensive tiers. Florida Blue, the state’s largest health insurer, listed all but one HIV drug on lower tiers requiring monthly co-pays of $10 to $70.
HIV patients aren’t the only ones being impacted by the plans with high deductibles and high co-insurance models for expensive drugs According to Steven Ullmann, director of the Center for Health Sector Management and Policy at the University of Miami’s School of Business Administration, hepatitis C and multiple sclerosis patients face the same high-cost challenges
Ullmann said cost-sharing presents a moral dilemma. “It’s one thing if you’re dealing with an elective pharmaceutical, but it’s another where you’re looking at drugs and treatment plans that affect one’s ability to sustain quality of life,” Ullmann told the Miami Herald. “But insurance companies are businesses, as well, and one recognizes their incentive structure: to avoid taking on too much risk.”
Ullmann said companies that offered low-cost HIV drugs last year may change their behavior this year based on the plans of their competitors.
“What we’re really worried about is a race to the bottom,” said Wayne Turner, a staff attorney at the National Health Law Program, which aided in filing the civil rights complaint. Turner said he fears the high-cost plans may have “skewed the market” and that in order to avoid having their risk pool burdened by people with expensive health needs, competitors may increase what they charge for HIV drugs.
Turner said that with the confusion of the exchange’s launch out of the way, the time was right “for the federal government to send a strong message to plans that they can’t design their benefits in a way that discriminates against people with HIV.”
In a statement to the Miami Herald, Aaron Albright, a spokesman for CMS, called the law’s anti-discrimination provisions “effective” and said the federal government was investigating complaints of discrimination.
Smith said he wouldn’t mind switching to the ACA if he knew that plans with sufficient coverage were waiting for him.
The state AICP program receives about half of its funding from the federal Ryan White HIV/AIDS Program, which helps provide medical care for about 500,000 HIV-positive people nationwide. By federal law, the Ryan White program is the “payer of last resort,” meaning many Floridians who can get cheaper coverage from another source, such as an ACA exchange, will now be required to do so.
Other HIV-positive patients will also be funneled to the exchange, including some clients of the state-administered AIDS Drug Assistance Program, which helps pay for HIV drugs for people who have low incomes or little or no insurance. The program receives 90 percent of its funds from the Ryan White program, meaning that those whose medication costs can be reduced by going onto an exchange will have to do so.
Nathan Dunn, a spokesman for the Florida Department of Health, said that this year about 4,000 of the 14,000 people enrolled in ADAP will have to sign up for federal marketplace coverage. The state would be in danger of losing its Ryan White program funding if it did not move people onto the exchange, according to the Miami Herald.
Photo of Steven Ullmann courtesy of University of Miami
