WASHINGTON—The National Health Law Program (NHeLP) welcomed yesterday’s announcement by Aetna that it will reduce the costs of HIV medications that had previously been priced as specialty drugs. NHeLP and The AIDS Institute (TAI) filed a complaint on May 29, 2014, with the U.S. Department of Health and Human Services Office for Civil Rights, charging four Florida health plans, including Aetna, with unlawful discrimination against people living with HIV and AIDS.
“We are pleased that Aetna is taking the right steps to ensure that people living with HIV can afford their medications,” said Elizabeth G. Taylor, NHeLP executive director. “Our complaint cited these barriers to accessing prescription drugs, and we are glad to see developments to remove them.”
“Aetna’s announcement protects people living with HIV/AIDS, but not those managing other serious or disabling medical conditions requiring costly medications that are often placed in similarly high cost-sharing tiers,” said Wayne Turner, NHeLP staff attorney. “NHeLP will continue our efforts so that all low-income individuals can benefit from the Affordable Care Act and access the care they need.”
Aetna has announced that it will begin moving HIV medications to a generic brand tier in all of its plans. This will lower co-payments, which were recently $1,000 a month for some medications, to a range of $5-$100, after deductibles. These reductions will be effective June 1, 2015.
In November 2014, Aetna and other Florida insurers reached agreements with the Florida Office of Insurance Regulation to address some of the discriminatory practices identified in the NHeLP/TAI pending federal complaint. The insurers had placed all HIV medications, including generics, on the highest cost-sharing tiers to discourage people with HIV/AIDS from enrolling, according to the complaint.
A recent study published in the New England Journal of Medicine, “Using Drugs to Discriminate,” confirmed that insurance companies are using adverse tiering to discriminate against people with HIV/AIDS. Citing the NHeLP/TAI complaint, the study reviewed 48 health plans and found that a dozen placed all medications used to treat HIV/AIDS in the highest cost-sharing tiers. The article also noted evidence of adverse tiering of drugs for other high cost conditions, such as cancer, diabetes and rheumatoid arthritis. As outlined in NHeLP’s February, 2015 commentary in the National Law Journal, this practice can seriously impair access to life-saving medications and runs afoul of the Affordable Care Act’s (ACA) protections. The ACA’s non-discrimination provisions ban health plans from discriminating against individuals based upon disability and prohibit health plans from discouraging enrollment by people with significant health needs.