Kaiser Health News: Some Plans Skew Drug Benefits To Drive Away Patients, Advocates Warn

By Michelle Andrews

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 recent complaint filed with federal officials.

The complaint, filed with the Office for Civil Rights at the federal Department of Health and Human Services, claims that the insurers—CoventryOne, Cigna, Humana and Preferred Medical—violated the health law 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 health law, 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, among other things.

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

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