Patient Access to Care: Insurance companies refuse to provide treatments to patients with HIV

Patient Access to Care: Fight to end insurance discrimination against people living with HIV

Insurance companies are making it difficult for patients living with HIV to gain access to life-saving treatments prescribed by their doctors.

Thankfully, the Center for Health Law and Policy Innovation of Harvard Law School is teaming up with patient advocacy groups to launch a new campaign to ensure patient access to care. The groups have filed formal administrative complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights. That’s the office responsible for enforcing the Affordable Care Act’s new anti-discrimination regulations in state ACA health insurance marketplaces.

The campaign’s goals are simple:

  • End insurance company policies and practices that prevent vulnerable patients from receiving the care and treatment they need
  • Stop insurance discrimination such as refusing to cover key medications
  • Prevent insurance companies from imposing high cost sharing to force patients to pay more for their medications and treatments

“CHLPI is using the OCR process to shine a light on discrimination occurring under the cloak of supposedly neutral insurance plan benefit design. When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication it violates federal law,” Robert Greenwald, the faculty director at the Center for Health Law and Policy Innovation of Harvard Law School, said in a press release. “These are landmark complaints that will benefit everyone looking to receive equitable, comprehensive health care through the Marketplaces by helping to define anti-discrimination law at a time when insurers are covering less and less.”

The Center for Health Law and Policy Innovation of Harvard Law School has partnered with the AIDS Research Consortium of Atlanta in Georgia, AIDS Alabama, AIDS Foundation of Chicago, CrescentCare (formerly the NO/AIDS Task Force) in Louisiana, Nashville CARES, AIDS Resource Center of Wisconsin, and AIDS Law Project of Pennsylvania. Complaints are being filed against:

  • Humana: Alabama, Georgia, Illinois, Louisiana, and Texas
  • Cigna: Georgia and Texas
  • Highmark: Pennsylvania
  • Independence Blue Cross: Pennsylvania
  • UPMC Health Plan: Pennsylvania
  • Community Health Choice: Texas
  • Anthem Blue Cross Blue Shield: Wisconsin

Georgia: AIDS Research Consortium of Atlanta takes on Humana and Cigna

Harvard’s Center for Health Law and Policy Innovation is taking the national lead, but it has critical support on a state-by-state level from local non-profit organizations.

In Georgia, the AIDS Research Consortium of Atlanta is the lead organization in a civil rights complaint against Humana and Cigna. The two insurance giants are charging patients living with HIV “an excessively expensive share of the costs for HIV drugs,” the Atlanta Journal-Constitution reports.

“Advances in HIV treatment mean that people living with HIV can lead long and productive lives, but only if they have continuous and uninterrupted access to HIV medications,” Dr. Melanie Thompson, ARCA’s Principal Investigator who led the local effort, said in a press release. “Lapses in HIV medications can lead to lifelong viral resistance and ultimately medication failure. Likewise, we should not forget that effective HIV treatment also prevents HIV transmission, so obstructing access to medications is a public health issue.”

Founded in 1988, the AIDS Research Consortium works with more than 50 physicians and 5 public health clinics to conduct clinical drug trials.

According to the Georgia complaints, insurance companies Humana and Cigna have been “obstruct(ing) the ability of people with HIV to access affordable life-saving medications to fight HIV, in violation of anti-discrimination provisions of the ACA.”

New Orleans: CrescentCare demands Humana cover life-saving medications

The Advocate’s Elizabeth Crisp covers the complaint filed against Humana on behalf of patients in Louisiana who have been denied access to life-saving treatments.

“One of Louisiana’s largest health insurers is facing a federal complaint from a New Orleans-based community health care provider that claims the company is discouraging people who need costly HIV medications from participating in its insurance plans,” The Advocate reports. “Humana offers insurance plans on the Affordable Care Act marketplace but the federal complaint… accuses the health insurance giant of routinely refusing to cover life-saving HIV medications or limiting access by charging customers a significant share of the costs for HIV drugs.

The effort to ensure that patients in Louisiana have access to life-saving care is being lead locally by CrescentCare.

“The outright refusal to cover medications, as well as unaffordable cost sharing are two detrimental barriers to care, and failure to monitor these practices will force individuals out of the health insurance market, leaving them without fundamental health care access,” CrescentCare Chief Executive Officer Noel Twilbeck said in a statement. “We must ensure that this does not occur.”

Alabama: Cigna discriminates against HIV patients

Over in Alabama, Humana has “discriminated against patients with HIV by requiring high payments for expensive, lifesaving drugs.”

“Patients with HIV typically take several prescription drugs that suppress the virus and keep the disease from progressing,” explains Alabama Media Group’s Amy Yurkanin. “Before the development of drugs to treat HIV, the virus ravaged patients’ immune systems, leaving them vulnerable to fatal infections.”

AIDS Alabama says that Humana has placed all HIV and Hepatitis C drugs “in a category that required patients to pay about half the cost of prescriptions.”

“For a lot of patients, that meant paying $1,700 out of pocket every month for drug costs,” Alex Smith, director of policy and advocacy for AIDS Alabama, told AL.com.

2014 Flashback: Insurers accused of discriminating against people with HIV

Sadly, this isn’t new. Insurance companies have a long history of engagin in insurance discrimination against patients living with HIV.

Back in 2014, the Wall Street Journal reported on Aetna, Cigna and Humana’s discrimination against people living with HIV.

“Patient advocacy groups are using antidiscrimination provisions in the health-care law as the basis of a complaint against insurers they say are trying to avoid covering consumers with HIV and AIDS, in one of the first cases of its kind.”

“The National Health Law Program and the AIDS Institute submitted a complaint to the Department of Health and Human Services’ Office of Civil Rights Thursday morning accusing four health insurers selling individual plans in Florida of discriminating against consumers with HIV in the way they designed their insurance benefits. The complaint names Coventry Health Care Inc., a unit of Aetna Inc., Cigna Corp., Humana Inc. and Preferred Medical, a plan based in Coral Gables, Fla.”

According to Time Magazine, “The two health organizations say the insurance companies, which offer plans in Florida through the federal online exchange, require that HIV and AIDS patients pay for a percentage of their drugs instead of a flat $10 co-pay. HIV and AIDS drugs can get expensive, so asking patients to pay 40% to 50% of the wholesale cost of their drug — thousands of dollars — becomes burdensome.”

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