AIDS Institute Praises FOIR For Requiring Insurers to Limit Cost of HIV Meds

The AIDS Institute praises the Florida Office of Insurance Regulation (FOIR) for requiring insurers to again limit patient cost-sharing for HIV medications as they submit for review their 2017 Qualified Health Plans (QHPs). In recently released guidance, similar to last year's, Florida states it will review plans for possible discriminatory practices for medications to treat HIV along with other health conditions. In a new requirement, the State will review formulary adequacy and adverse tiering for certain chronic health conditions, including HIV, hepatitis C, breast and prostate cancer, rheumatoid arthritis, bipolar disorder and schizophrenia, diabetes, and multiple sclerosis. �

In addition to reviewing plans and not certifying them if they utilize discriminatory benefit design, such as placing all or most drugs to treat a certain condition on the highest tier, Florida will review plans for discriminatory benefit implementation and medical management techniques. The delivery of any drug only through the mail will continue to be prohibited.�Cost-sharing�for HIV drugs again will be limited to $40, $70, or $150 per 30-day supply, depending on the medication.�One injectable medication will have a co-pay limit of $200.� � �

"We thank the Florida Office of Insurance Regulation for continuing to recognize that an insurer charging excessive co-insurance is discrimination and harms people with HIV, hepatitis, and others who rely on medications to keep them healthy," commented Carl Schmid, Deputy Executive Director for The AIDS Institute. "Florida's proactive steps to protect patients is an example for other states to follow."�

The AIDS Institute, based in Tampa, Florida, first highlighted the issue of some QHPs under the Affordable Care Act (ACA) placing all HIV medications on the highest tier, including generics, and charging consumers 30, 40 or even 50 percent co-insurance. In May 2014, The AIDS Institute and the National Health Law Program (NHeLP) filed a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, charging four Florida health plans with unlawful discrimination.�

While a review of Florida's 2016 QHPs reveals that plans, for the most part, are limiting patient cost-sharing for HIV medications, some were still not covering all HIV drugs and, most notably, are substantially increasing deductibles. However, for hepatitis B and C treatments, The AIDS Institute found that six out of the nine major insurers offering QHPs in Florida are charging beneficiaries coinsurance as high as 20 to 50 percent for all or almost all hepatitis B and C drugs.�

Earlier this month, The AIDS Institute joined the Alliance for Patient Access and sent a letter asking the Florida Insurance Commissioner to review these plans and stop them from using these discriminatory practices, which include excessive prior authorization procedures. �

"The Florida Office of Insurance Regulation's actions under Commissioner Kevin McCarty has helped ensure that people living with HIV/AIDS and other Floridians who depend on prescription medications have greater access to essential medicines at a more affordable cost," said Michael Ruppal, Executive Director for The AIDS Institute. "We are thankful for Commissioner McCarty's leadership for the past 13 plus years, and will look to his successor, David Altmaier, to continue to ensure that these discriminatory insurance policies are prohibited and strong state and federal patient protections are enforced." �

The AIDS Institute is a national nonprofit organization that promotes�action for social change through public policy research, advocacy and education.
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For more information, visit www.TheAIDSInstitute.org�