MIAMI (AP) — Patient advocates in the U.S. say some insurance companies are making HIV and AIDS drugs unaffordable in plans issued through the country's new health care law by shifting much of the cost to customers.
While the issue applies broadly to all patients with chronic illnesses that require expensive medication, HIV and AIDS advocates say they are the first to file a formal complaint with the government about pricing.
Under President Obama's Affordable Care Act, the signature legislation of his time in office, insurance companies are forbidden from turning away consumers with pre-existing conditions. But advocacy groups allege insurance companies are discouraging HIV and AIDS patients, who are expensive to cover, by requiring them to pay a percentage of costly medications instead of a flat payment, essentially pricing the medications out of reach.
The new health law has been under immense scrutiny in the U.S., especially by Republicans, who are eager to see it overturned. The law was meant to provide coverage to millions of Americans who normally went uninsured.
The rollout of the law hasn't been easy.
Several insurance companies are impeding access to services by requiring re-authorization for drugs consumers have been taking for years or making the claims process difficult, says Carl Schmid, deputy executive director of The AIDS Institute. The group filed a complaint with U.S. Health and Human Services officials this year against four Florida insurance companies, and advocates in other states are considering similar action.
Georgia advocates are planning to file a similar complaint with federal officials, said Dr. Melanie Thompson. Advocacy groups say they are finding similar problems with some exchange plans in Ohio, California and Illinois.
HHS said it's reviewing the complaint in Florida but declined further comment.
Advocates say intervention by the federal government would also benefit patients who take expensive medications for chronic conditions such as blood cancer and rheumatoid arthritis.
The problem arises from how drugs are priced by insurance companies. For the bulk of drugs, consumers pay just a fixed amount, usually about $30 to $45 a prescription. However, insurance companies have taken some of the most expensive drugs and put them in a special category, where they require patients to pay as much as 50 percent of the total cost.
While insurance companies face high costs in treating many cancer and hepatitis patients, the costs are more acute when a patient has a chronic, incurable health issue — for example HIV or multiple sclerosis — since they will have to take the expensive medications for the rest of their lives.
"By putting the drugs that are recommended up on the highest tiers in an unaffordable place they are in essence discriminating against people with HIV because these are the lifesaving drugs they require to survive," Thompson said. Advocates are quick to point out that many of the seriously ill patients now enrolled in ACA plans had trouble finding insurance before the law was passed, but say something needs to be done about the drug costs.
Insurance companies said in separate statements that their plans follow the latest HHS guidelines, cover all medically necessary HIV drugs and offer a variety of choices.
But insurers say drug makers are charging increasingly exorbitant prices for medications, said Brendan Buck, spokesman for the insurance trade group America's Health Insurance Plans.
Around the country, state and local groups like the Aids Drug Assistance Programs (ADAP) and Ryan White Programs help patients with prescription drug costs, but typically focus on the uninsured and underinsured.