Humana Agrees to Serious Cuts in HIV Drug Costs for Florida

The AIDS Institute welcomes an agreement between Humana Medical Plan and the Florida Office of Insurance Regulation that significantly reduces patient cost-sharing for all HIV drugs on qualified health plans offered by Humana in the Florida marketplace.

As part of the agreement, Humana will lower patient cost sharing of HIV drugs from 50 percent to 10 percent co-insurance for the more costly HIV medications. For HIV drugs that are less than $600, Humana will lower the cost to patients from 50 percent co-insurance to a $50 co-pay.

The AIDS Institute and the National Health Law Program (NHeLP) filed a complaint on May 29, 2014, with the U.S. Department of Health and Human Services Office for Civil Rights, charging four Florida health plans, including Humana, with unlawful discrimination against people living with HIV and AIDS. The four insurers placed all HIV medications, including generics, on the highest cost-sharing tiers with high levels of co-insurance.

According to the complaint, this discourages people with HIV/AIDS from enrolling in their plans. Such practices are prohibited under the Affordable Care Act's non-discrimination provisions, which ban health plans from discriminating against individuals based upon disability and prohibit health plans from discouraging enrollment by people with significant health needs.

"We thank Florida Insurance Commissioner Kevin McCarty for the steps he has taken to protect patients in Florida", stated Michael Ruppal, executive director for The AIDS Institute. "We also thank Humana for recognizing that charging excessive co-insurance is wrong and harmful to people with HIV who cannot afford to take their medications."

As part of the agreement Humana admits no wrongdoing. The cost-sharing reductions to which it has agreed apply only for the 2015 plan year. In addition, Humana has agreed to meet with HIV/AIDS organizations and pharmaceutical manufacturers to discuss long-term solutions to address affordability and accessibility to specialty drugs.

Neither NHeLP nor The AIDS Institute was a party to the agreement with Humana. The agreement does not address the specific legal claims that are pending in the federal complaint. In the recent Notice of Benefit and Payment Parameters for 2016 HHS stated "if an issuer places most or all drugs that treat a specific condition on the highest cost tiers, we believe that such plan designs effectively discriminate against, or discourage enrollment by, individuals who have those chronic conditions." However, HHS still has not acted on the federal complaint filed by NHeLP and The AIDS Institute.

The Florida Commissioner recently reached separate consent orders with Cigna and Coventry (Aetna). In both those agreements, the insurers agreed to limit patient cost sharing for only four HIV drugs to $200. The agreement with Humana impacts all HIV drugs and will result in an overall lowering of patient cost-sharing. Other plans in Florida cap the cost of HIV drugs at more reasonable co-pays ranging from $10 to $160.

"This agreement will help ensure that people living with HIV/AIDS will have greater access to essential medicines in Florida at a more affordable cost," said Carl Schmid, deputy executive director for The AIDS Institute. "However, much work needs to be done. This only impacts one insurance company in one state for people with one health condition for one year. We look forward to working with Humana and other insurers to address continuing barriers to care, including inadequate drug formularies, high co-insurance and deductibles, for people with HIV/AIDS and other chronic health conditions."

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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