The complaints, presented by Harvard Law School’s Center for Health Law and Policy Innovation, contend seven insurers routinely denied coverage for HIV medications or limited access to needed medications through prohibitively high cost sharing.
The seven insurers listed in the complaints are: Humana (complaints filed in Alabama, Georgia, Illinois, Louisiana, Tennessee and Texas); Cigna (complaints filed in Georgia, Tennessee and Texas); Highmark (a complaint filed in Pennsylvania); Independence Blue Cross (a complaint filed in Pennsylvania); UPMC Health Plan (a complaint filed in Pennsylvania); Community Health Choice (a complaint filed in Texas); and Anthem Blue Cross Blue Shield (a complaint filed in Wisconsin).
Harvard Law School’s Center for Health Law and Policy Innovation, in collaboration with local HIV groups in several states, looked at hundreds of silver-level plans sold on the marketplaces to determine whether their formularies would allow access to six treatment regimens that are the current standard of care for treating newly diagnosed HIV patients, according to Kaiser Health News. They also looked at the plans’ cost-sharing requirements, Kevin Costello, director of litigation at the health law center, said in the report.
They found, for example, this year Anthem silver plans in Wisconsin cover only four of the 16 drugs or combination products recommended to meet the current care standard, reports Kaiser Health News.
Alex Kepnes, Humana’s director of corporate communications, defended the insurer’s practices in a statement used by Kaiser Health News. “All Humana health insurance plans offered through the health insurance marketplace fully comply with state and federal laws and regulations,” he said, adding, “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.”
Anthem public relations director Scott Larrivee also weighed in, saying in the report: “Anthem Blue Cross and Blue Shield 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. Anthem Blue Cross and Blue Shield in Wisconsin covers more than a dozen medications for the treatment of HIV/AIDS and all required therapeutic drug categories are included on our formulary/drug list which is compliant with (marketplace) requirements.”
Cigna spokesman Mark Slitt declined to comment in the report, saying the company does not comment on pending legal matters.
The complaints are part of an advocacy campaign by Harvard Law School’s Center for Health Law and Policy Innovation to enforce healthcare rights for people living with HIV in seven states.
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