Miami-Dade County

Florida insurance regulator limits HIV drug costs for patients

HIV medications

A year-long battle to decrease discrimination toward HIV patients by health insurers reached another milestone in late March when the Florida Office of Insurance Regulation announced it would limit HIV patient costs and screen 2016 Affordable Care Act plans for discriminatory practices.

In a memo to insurers, Florida’s insurance regulation office noted it will “ensure the plan’s benefit design is not unfairly discriminatory” for all prescription medications and will particularly take close notice of the way plans price HIV medications, which can have co-pays of more than $1,000 a month.

Plans will be required to price their HIV medications in a way that is “substantially similar to the benchmark plan or is otherwise compliant with Florida and federal law,” the office said in its memo. The co-pay, or the share of the cost consumer’s pay, will be capped between $40 and $150 for a 30-day supply of medication. One injectible, Fuzeon, will be capped at $200.

The announcement marks a push spearheaded by Tampa-based nonprofit, the AIDS Institute, which filed a civil rights complaint in May 2014 with the federal government alleging that four insurers — Preferred Medical Plan, Humana, Cigna and Coventry — were discriminating against HIV patients by making their medications too expensive. The complaint is still pending.

Following the complaint, the insurers agreed to lower their costs for the most common HIV drugs — Atripla, Complera, Stribild — while Humana, Coventry and Aetna also agreed to lower cost sharing for all HIV medications.

Now, said Carl Schmid, deputy executive director of The AIDS Institute, the Florida office is stepping up, making sure that all plans are stripping discriminatory practices from their price schemes.

“This will definitely help patients access their medication and stop this abuse by some insurance companies,” Schmid said. “It’s extremely good progress.”

Miami-Dade County has the highest rate of HIV infection cases in Florida, according to state data.

Schmid said it remains to be seen how the office will enforce compliance by insurers, but Amy Bogner, a spokeswoman for the office, said it is “striving to ensure compliance by enforcing Florida law on this issue.”

Follow @MHhealth for health news from South Florida and around the nation. This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.