The health insurance company Cigna has agreed to change its prescription drug policy to ensure that Florida consumers with HIV and AIDS can access their medications, Florida insurance officials said Friday.
The decision comes months after two national health organizations filed a complaint with the federal government alleging that Cigna and three other insurance companies are violating the Affordable Care Act by structuring their Florida insurance plans in a way that discourage consumers with HIV and AIDS from choosing those plans.
The complaint from the National Health Law Program and The AIDS Institute alleged Cigna and three other insurance companies are placing HIV and AIDS medications in the highest tier of their drug formulary, requiring prior authorizations to fill prescriptions, and implementing unnecessary and discriminatory step protocols. They're also requiring HIV and AIDS patients to pay a percentage, often up to 40 or 50 percent of their drugs instead of a flat co-pay, which could run into the thousands of dollars.
Under the agreement, Cigna said generic drugs currently included in the higher cost specialty tiers will be transferred to a lower cost tier. The insurer is also capping customers' costs on the drugs Atripla, Complera, Stribild, and Fuzeon to $200 per month. Cigna is also removing the 30-day supply limit per prescription for HIV drugs, the company said in a statement.
"People living with HIV/AIDS have been experiencing illegal barriers to accessing insurance, including by Cigna," Carl Schmid, deputy executive director of The AIDS Institute, said in an email. "This consent order is a step in the right direction to addressing these barriers."
State insurance officials did not comment on the allegations with the three other insurers.
"I am committed to making sure insurers are not acting in a manner that is discriminatory and inconsistent with Florida law and today's announcement shows Cigna is committed to those principles as well," Florida Insurance Commissioner Kevin M. McCarty said in a statement.
The Affordable Care Act forbids insurers from discriminating against those with pre-existing conditions, but health advocates warn some insurers are finding ways around that by structuring their plans in a way that discourages consumers with chronic conditions from choosing them.
Health advocates say high costs cause patients to skip doses or go off their medications altogether, causing serious health complications.