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Celebrating Successes: Protecting access to affordable and quality coverage and care for people living with HIV

This blog post was originally published on the Community Catalyst Health Policy Hub on November 25, 2014.

Celebrating Successes: Protecting access to affordable and quality coverage and care for people living with HIV

by Carmel Shachar and Malinda Ellwood

Dedicated advocacy has led to important successes in protecting health insurance coverage and health care access for people living with HIV. Below are three recent successes, both advocates working at the state and federal levels.

Illinois – Successful Advocacy for Regulations to Protect Consumers from Industry Practices.

AIDS Foundation of Chicago, AIDS Legal Council of Chicago and Jenner & Block recently drew attention to harmful and discriminatory health insurance industry practices of Illinois health insurers. In response to discriminatory practices they observed within qualified health plans in Illinois, they sent a complaint to the Illinois Department of Insurance including specific examples of coverage exclusions, burdensome prior authorization processes and other problematic practices. In response, the Department of Insurance issued a bulletin to insurers suggesting plans that fail to cover all HIV drugs as recommended by the Department of Health and Human Services (HHS) and plans who institute burdensome and redundant prior authorization requirements may be found to be discriminatory.

Florida – Successful Advocacy for Lowered Cost-Sharing and Prices for Cigna Enrollees Living with HIV.

The AIDS Institute and the National Health Law Program filed a complaint with HHS’s Office of Civil Rights regarding the discrimination practices that Cigna and three other Florida insurers implemented regarding HIV medications. These insurers placed all HIV medications, including generics, on specialty drug tiers. As a result, enrollees had to pay 40 percent – 50 percent of the cost of these medications, making them prohibitively expensive. Last month and in response to this complaint, Cigna entered into a consent order with Florida insurance regulators to agree to move generic HIV drugs to a lower-cost tier, limit copays to $200 a month for other HIV medications and to no longer require prior authorization for refills. The discrimination complaint is still under review by federal regulators.

National – Successful Advocacy for a Federal Rule Requiring Insurers to Accept Payments from Ryan White.

As we discussed in a previous blog, health plans in some states stopped accepting premium payments from the Ryan White/AIDS Drug Assistance Programs on behalf of enrollees. This was problematic because many individuals living with HIV rely on Ryan White to assist with the financial burden of HIV treatment and care, including cost-sharing payments for HIV medications. The Centers for Medicare and Medicaid Services (CMS), in response and under pressure from advocates, released a rule requiring health insurance companies participating in the Marketplaces to accept third party payments from Ryan White. However, reports from other states indicate that health insurance plans have a tendency to lose track of third party payments, resulting in some consumers receiving termination from coverage warnings for “failure to pay premiums.”

It is critical to continue advocacy efforts to end discriminatory practices that pose barriers to meaningful coverage for people living with HIV.

The views reflected in this blog are those of the individual authors and do not necessarily represent those of the Center for Health Law & Policy Innovation or Harvard Law School. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.

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