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Aetna, Cigna & several additional insurers Lower HIV Meds Costs
  "Two hundred dollars a month just isn't realistic for me," said Smith, a self-employed notary. "There's no way I can afford that."
Aetna Inc Announces Policy Change Following Complaints From AIDS Institute And National Health Program
Aetna has succumbed to pressure from the National Health Institute as well as the AIDS Institute; it has now announced it will cut out-of-pocket payments for its HIV and AIDS drugs
Published: Mar 27, 2015 at 8:54 am EST
Managed healthcare company Aetna Inc has announced that it will cut out-of-pocket payments for most of its HIV and AIDS drugs, which will now amount to anywhere between $5 and $100 after deductibles.
The decision to do so has come about in the aftermath of a complaint filed by the AIDS Institute as well as the National Health Program against the company as well as Humana Inc and Cigna Corporation, who claimed that the three companies have tried to steer HIV and AIDS patients away from plans being offered in the federal insurance exchange in Florida by limiting coverage of HIV medications.
These complaints are backed by the fact that these three insurers require exorbitant out-of-pocket spending even for mid-level "silver plans" offered in Florida, thereby limiting access to these drugs for patients. The phenomenon, however, runs contrary to research which indicates that reducing costs for patients for drugs actually increases patient compliance with drug therapies, which, in turn, improves outcomes and cuts costs of healthcare.
Aetna's co-payment reductions will go in effect from June 1 onward and continue nationwide in the individual market through 2016, as per the announcement. Aetna, as of now, groups all HIV drugs in its highest tier, charging US patients about 50% or as much as $1,000 for a monthly dose of some popular medications, as per the AIDS Institute.
Second Florida insurer strikes deal with state over HIV drugs
By Nicholas Nehamas
11/21/2014 5:12 PM
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In the wake of a federal civil rights complaint alleging that four Florida insurers discriminated against people with HIV/AIDS, Coventry Health Care has reached a deal with state regulators to reduce the costs of its HIV drugs for some Florida residents signing up for health insurance under the Affordable Care Act.
Cigna agreed to a similar arrangement with the Florida Office of Insurance Regulation two weeks ago.
As part of the deal, both insurers will cap the amount consumers pay for four widely prescribed medications - Atripla, Complera, Stribild and Fuzeon - at $200 a month for 2015 plans offered on the federal healthcare exchange. The companies also agreed to move their generic HIV drugs from a more expensive "specialty" tier to a less expensive tier for generics.
The complaint, filed in May by the Tampa-based AIDS Institute and the National Health Law Program in Washington, D.C., accused the insurers of making their HIV drugs so expensive for 2014 plans that consumers could not afford them.
Florida law prevents insurers from discriminating against those with HIV. The U.S. Department of Health and Human Services is still investigating the complaint, which also named Humana and Preferred Medical.
Neither Cigna nor Coventry admitted to any wrongdoing in their agreements with the state. "We are voluntarily updating our plans in order to ensure we are compliant with Florida law," said Walt Cherniak, a spokesman for Aetna, which owns Coventry.
Even with the deal, consumers may still have trouble paying for the medications their lives depend on.
Tony Smith, 42, of Coral Springs, was diagnosed with HIV in 2008. He said under his current Cigna plan he pays $85 for a three-month supply of Atripla. But Cigna isn't offering that plan next year and Smith will need to sign up for new insurance on the federal exchange.
"Two hundred dollars a month just isn't realistic for me," said Smith, a self-employed notary. "There's no way I can afford that."
Smith said he may be forced to reduce his income in order to qualify for the federal Ryan White HIV/AIDS program, which would pay all his medication costs. The health advocacy groups that filed the complaint insist the federal government must address the problem.
"What we want to see are standards being articulated and applied across the nation," said Wayne Turner, a staff attorney with the National Health Law Program.
And Cigna and Coventry aren't capping costs for consumers in other states where they offer plans, pointed out Carl Schmid, deputy executive director of the AIDS Institute.
"There is still a macro issue of patient access to care that hasn't been resolved," Schmid said.
This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
Fourth Florida Insurer Agrees To Cap Cost Of HIV Drugs
By Nicholas Nehamas, Miami Herald January 22, 2015
The last of four Florida insurers blasted by AIDS activists for the high cost of their HIV drugs relented last week, saying it would cap what patients pay every month for four types of medication.
"We will voluntarily agree to set an out-of-pocket limitation of $200 per month on each of the following drugs: Atripla, Complera, Stribild, and Fuzeon," Preferred Medical Plan CEO Tamara Meyerson wrote to Kevin McCarty, commissioner of the Florida Office of Insurance Regulation, in a Jan. 14 letter.
The other three companies - Coventry Health Care, Humana and Cigna - had earlier reached formal agreements with state regulators to lower their prices and to fill prescriptions without prior authorization for 2015.
Preferred did not violate Florida's anti-discrimination laws, said Amy Bogner, a spokeswoman for the state's insurance office.
An estimated 120,000 Floridians have HIV, and nearly half of them live in South Florida, according to state data.
The four Florida insurers were the focus of a federal civil rights complaint filed last May by The AIDS Institute, a nonprofit group in Tampa. The complaint accused insurers of discriminating against people with HIV by making their medications too expensive - as much as $1,500 per month for drugs on some health plans offered in Florida last year.
The U.S. Department of Health and Human Services is still investigating the complaint, according to spokeswoman Rachel Seeger.
Carl Schmid, deputy executive director of The AIDS Institute, said he was disappointed the state did not ask Preferred to sign a more extensive agreement. "What's in the letter is really nominal," Schmid said. "It doesn't even say how long Preferred has to abide by these terms."
But David Poole, a spokesman for the AIDS Healthcare Foundation, which worked with state regulators on the drug pricing issue, called the letter "acceptable" and said all insurers should ensure antiretroviral medications are "accessible and not economically out of reach."
The news comes as Gov. Rick Scott confirmed that he was seeking to replace McCarty, who has led Florida's insurance regulator since 2003.
AHF yesterday sent a letter to the governor praising McCarty's work on the pricing of HIV drugs.
"The actions of the commissioner and his staff assured ... that public health in Florida would not suffer because of the restrictive actions the private insurance companies had instituted," the letter said.
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