Insurance companies have been accused of discriminating against HIV patients allegedly by forcing them to pay high co-insurance rates for drugs.
Two companies operating plans in Georgia, and others in different parts of the country, face formal complaints filed with the U.S. Department of Health and Human Services.
Humana and Cigna are likely to be the subjects of investigations under anti-discrimination provisions of the Affordable Care Act. They are accused of offering discriminatory health insurance plans under the Georgia exchange that made access to medicines prohibitively expensive or inaccessible.
The complaints were filed with the Office of Civil Rights (OCR) by the Atlanta-based AIDS Research Consortium of Atlanta (ARCA) and the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI).
Similar complaints against insurance companies were simultaneously filed in six other states: Texas, Illinois, Alabama, Louisiana, Wisconsin and Pennsylvania.
Dr. Melanie Thompson, ARCA’s principal investigator, said patients were forced to pay huge amounts of out-of-pocket cash, sometimes up to 50 percent for highly expensive drugs, ones they needed continuously to survive.
“So they were bumping up against high and prohibitive drug costs, or could not access these medicines at all,” Dr. Thompson told Patient Daily.
Her research and advocacy group partnered with the Harvard center to investigate and carry out an analysis to find out what was happening.
Researchers said patients were on a tier that required them to pay co-insurance, a cost share, of up to 50 percent. In addition, their plans often included a requirement to get prior authorization from the insurance companies before they could be prescribed a drug.
“Cigna and Humana stood out through their alleged discriminatory handling of the drugs, alleged discrimination because other insurance companies were not doing this,” Thompson said.
Other companies were offering the same drugs without the large cost share, Thompson said.
Researchers also looked at the plans offered to patients on similarly expensive chronic pain medication.
They found, according to the complaint filed with the OCR, that patients with rheumatoid arthritis were on a tier level with flat co-pays of $60. Those with HIV paid up to $800, Thompson said.
“There are a lot of ramifications,” Thompson said. “People with HIV have to be on continuous medication; they can’t just take a break -- that has a real impact on their health.”
It is a public health issue, and it is unfair competition in the market when companies cherry-pick patients, discouraging those with expensive medicines from joining up, Thompson said.
“It is anti-competitive as companies that are playing fair end up paying more money, and may leave the marketplace entirely,” Thompson said.
Several news outlets in the Atlanta area attempted to make contact with Cigna and Humana, but did not get a response.
A spokesman for Cigna did tell Channel 2 Action News in Atlanta that the company does not comment on litigation matters.
The OCR, if it investigates and finds insurance companies discriminated against patients, can levy monetary penalties and restrict them from offering certain plans.
"But we would like to see the companies make their own adjustments so their plans are fair,” Thompson said, adding that she hopes they do so before open enrollment Nov. 1.
“I do want to say it's a really wonderful thing about the ACA that it has discrimination provisions built in because this gives citizens an opportunity to require companies to abide by the law, and not discriminate against people.”