Major Insurer Announces Huge Cuts to HIV Medication Copayments

Relief is in sight for those who have been paying outrageous prices for their HIV meds. Atena, the country’s third-largest insurance company, has announced plans to dramatically  lower their copayment prices for HIV prescription drugs.

When the Affordable Care Act went into effect many patients and health advocates thought it would finally make HIV medications available to everyone. But that wasn’t exactly what happened. Instead, many insurers have been charging copayments of more than $1,000 a month for some treatment regimes, making it impossible for many patients to access lifesaving medications.

Activists have long argued that this pricing is deliberately discriminatory, maintaining that insurance companies charge egregious prices in order to stop HIV-positive patients from signing up for  —  or staying on — their plans. Encouraging poz consumers to shop elsewhere may save the insurance companies millions of dollars, but activists have argued that it violates the federal requirement that insurers offer coverage to everyone no matter how healthy or ill they are.

HIV rights advocates have been petitioning insurers to reduce the expenses voluntarily rather than having to be forced into doing so via a court decision or federal mandate.

In 2014, National Health Law Program and AIDS Institute filed a federal civil rights complaint against four insurance companies offering plans in Florida. The complaint revolves around the way insurance companies have been classifying drugs into cost categories, known as tiers. Insurers including Atena, Cigna, and Humana have reportedly been placing nearly all HIV medications — as well as drugs treating frequently concurrent diseases like hepatitis C —  in the highest-cost category and designating them as “specialty drugs.”

In a 2014 settlement brokered by the Florida Department of Insurance, Atena and its subsidiary Coventry, admitted no wrong-doing but agreed to significantly reduce out-of-pocket costs for HIV medications for its Florida members. Then last month, the federal Centers for Medicare and Medicaid Services came down on the side of HIV advocates, issuing a new rule for 2016 that will prohibit all insurance plans nationwide from placing “most or all drugs that treat a specific condition on the highest cost tiers” or charging more for single-tablet regimens. 

Now Aetna says it will lower prices throughout the country in 2015, by moving HIV meds from a specialty tier to either a generic or non-preferred brand tier. And the savings will be significant rather than chump change.  In fact it may literally save individuals with HIV thousands of dollars a year. Aetna is reportedly reducing the copayments to $5 to $100 after deductibles are met.

“Aetna’s announcement will help ensure that people living with HIV/AIDS throughout the country will have greater access to essential medicines at a more affordable cost,” Michael Ruppal, executive director of The AIDS Institute, said in the statement.

“This is a major victory for people living with HIV who rely on medications to remain healthy,” added Carl Schmid, also of The AIDS Institute. “We thank Aetna for recognizing that charging excessive co-insurance is wrong and harmful to people with HIV who cannot afford the cost of their medications.”

In Illinois, Coventry, which is owed by Aetna, announced it will also be making the change in 2015, prompting Tom Yates, executive director of AIDS Legal Council of Chicago to respond, "We deeply appreciate the open dialogue we had with Coventry. We shared our concerns, and they listened and talked with us. We are thankful that they are changing their coverage policies in Illinois and the other states in which they offer Marketplace plans.  This change will have a national impact.”

“We urge the federal government to take immediate enforcement action against other national plans that are placing all HIV medications on the highest cost-sharing tiers,” added John Peller, president/CEO of AIDS Foundation of Chicago, which was part of the long negotiations with Coventry. “Such coverage policies impede access to care for people with HIV and may be discriminatory.”

“However,” Ruppal noted, “There are still many other insurers who are charging patients excessive costs for their HIV medications.”

A spokesman from Humana, which was also warned about its drug pricing, said in a statement Friday that the company is "in the process of developing options to address the high cost of certain specialty drugs." The statement did not specifically address the costs of HIV medications.

Atena’s new policy and pricing plan will go into effect nationwide, beginning June 1, 2015.