Complaint Says Insurance Plans Discriminate Against HIV Patients

HIV/AIDS drugs like AZT are lifesavers for many people. But insurers' policies on paying for the drugs vary widely.

hide captionHIV/AIDS drugs like AZT are lifesavers for many people. But insurers’ policies on paying for the drugs vary widely.


Will Deni McIntyre/Science Source

Four Florida insurers allegedly discriminate against people with HIV/AIDS by structuring their prescription drug benefits so that patients are discouraged from enrolling, according to a complaint filed by health advocacy groups.

According to the complaint filed with the Office for Civil Rights at the federal Department of Health and Human Services, the insurers — CoventryOne, Cigna, Humana and Preferred Medical — violated the Affordable Care Act and federal civil rights laws by placing all covered HIV/AIDS drugs, including generics, in the highest drug tiers that require significant patient cost sharing.

The complaint was made by the AIDS Institute and the National Health Law Program, which are health advocacy organizations.

Under the Affordable Care Act, insurers are prohibited from rejecting customers because of medical conditions. They also cannot offer plans with benefit designs that discriminate based on someone’s degree of disability, health conditions or expected length of life.

People with other serious medical conditions face similar prescription drug cost-sharing problems, says Dan Mendelson, CEO of Avalere Health, which conducted an analysis of 123 exchange plan formularies that included every state.

Expensive prescriptions drugs can stretch people's finances, even if they have insurance.