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New Orleans group joins federal complaint against HIV drug costs/ lawsuit vs Humana for overcharges/access
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. Humana offers insurance plans on the Affordable Care Act marketplace but the federal complaint, which was filed jointly by CrescentCare and the Center for Health Law & Policy Innovation at Harvard Law School, 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 complaint, which was submitted Tuesday to the U.S. Department of Health and Human Services' Office for Civil Rights, argues that Humana is violating the anti-discrimination provision of the Affordable Care Act.
"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."
Humana disagrees with the characterizations outlined in the complaint and says that all of its plans are in full compliance with state and federal laws and regulations. The company further argues that the high cost of HIV treatment options, in general, is to blame. "These offerings are designed to provide affordable access to comprehensive coverage for all consumers, including those living with HIV/AIDS and other illnesses," the company said in a statement. "To help maintain overall affordability of coverage, Humana places prescription drugs on various tiers based on neutral and clinical criteria. The specialty drug tier is limited to prescription drugs costing more than $600 per prescription. 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 mitigate pharmaceutical manufacturer pricing."
Similar complaints were filed against insurers in six other states, including five other states where Humana has plans.
"When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication it violates federal law," CHLPI's faculty director Robert Greenwald said in a statement. "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."
Humana, in the company's statement, said it's committed to remaining on the ACA marketplace in 11 states, despite challenges, including "the challenges of maintaining affordability of coverage in light of ever-escalating prescription drug costs - especially specialty drugs - which serves as one of the greatest drivers of increased cost."
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