US Public Policy and News


Florida Insurance Commissioner Reaches Agreement with Insurer to Protect People with HIV/AIDS



Florida Insurance Commissioner Reaches Agreement with Insurer to Protect People with HIV/AIDS
The AIDS Institute

WASHINGTON-The National Health Law Program (NHeLP) and The AIDS Institute welcomed the Florida Office of Insurance Regulation's announcement this morning that it has reached a Consent Order with Cigna Health and Life Insurance Company that addresses some of the discriminatory practices identified in their pending federal complaint against Cigna.


"This is a welcomed development," said Wayne Turner, NHeLP staff attorney. "As we laid out in our federal complaint earlier this year, people living with HIV/AIDS have been experiencing illegal barriers to accessing insurance, including by Cigna. This consent order is a step in the right direction to addressing these barriers."


"We thank the Florida Insurance Commissioner for taking these first steps to ensure that people living with HIV/AIDS will have greater access to essential medicines in Florida at a more affordable cost," said Carl Schmid, deputy executive director for The AIDS Institute. "However, much work needs to be done by the insurance companies to address additional barriers to care for people with HIV/AIDS, including inadequate drug formularies, high co-insurance and deductibles."


The AIDS Institute and NHeLP filed the complaint on May 29, 2014, with the U.S. Department of Health and Human Services Office for Civil Rights, charging four Florida health plans, including Cigna, with unlawful discrimination against people living with HIV and AIDS. The four insurers placed all HIV medications, including generics, on the highest cost-sharing tiers with high levels of co-insurance to discourage people with HIV/AIDS from enrolling, according to the complaint. Such practices are now prohibited under the Affordable Care Act's non-discrimination provisions, which ban health plans from discriminating against individuals based upon disability and prohibit health plans from discouraging enrollment by people with significant health needs.


While the Consent Order admits no wrongdoing, Cigna has agreed to restructure its HIV prescription drug benefits for the 2015 plan. Among other things, they will limit co-pays to $200 per month for four HIV drugs instead of charging patients 40-50 percent co-insurance for all HIV drugs. Cigna will also place all generic HIV medications into a lower cost "generic" tier, and will eliminate burdensome prior authorization requirements for refills of HIV/AIDS drugs and step therapy requirements for administration of these drugs. The Consent Order requires Cigna to meet with NHeLP, The AIDS Institute and AIDS Healthcare Foundation to address HIV/AIDS drug affordability and access issues more broadly.


"We thank Commissioner Kevin M. McCarty for the steps he has taken to protect patients in Florida", stated Michael Ruppal, executive director for The AIDS Institute. "The Commissioner's inclusion of community organizations like ours to meet with Cigna provides additional opportunities to eliminate barriers that restrict access for our patients."


Today's Consent Order, which neither NHeLP nor The AIDS Institute were a party to, applies only to Cigna. The order does not address the specific legal claims that are pending in the federal complaint, including claims regarding discriminatory plan benefit designs. In addition, the order does not affect the complaints pending against other Florida insurance companies.


"We will continue working so that all health plans comply with federal non-discrimination laws that prohibit egregious insurance company practices," added Turner. "It remains the responsibility of federal officials to ensure that these federal protections are properly monitored and fully enforced."


"In the next week, we will learn how Cigna and other insurers in Florida and across the country will structure their 2015 qualified health plans," continued Schmid. "We are looking forward to seeing plans that will make health insurance work for people living with HIV/AIDS and others with chronic health conditions."


For more information, contact: Wayne Turner (NHeLP staff attorney) at 202-289-7661 ext. 307 and Carl Schmid (The AIDS Institute deputy executive director) at 202-669-8267.