AIDS Institute Calls For Florida Insurers to Remove Barriers to Hep C Cures

Today, in a letter to Florida Insurance Commissioner Kevin McCarty, the Alliance for Patient Access (AfPA) joined with Tampa-based The AIDS Institute to call on Florida insurers to remove barriers to access to Hepatitis C medications for Qualified Health Plan enrollees who are eligible to receive treatment, according to clinical practice standards and federal law.

A new generation of Hepatitis C medications, like Harvoni, Sovaldi, and Viekira Pak, have a more than 90 percent cure rate. However, due to insurance companies' high coinsurance and deductibles, which many patients cannot afford, and their rigorous prior authorization requirements, eligible patients' ability to receive treatment is jeopardized. Several insurers are requiring their enrollees to pay 30, 40 or even 50 percent cost of the drug and a deductible that can be higher than $4,000.

Hepatitis C (HCV) is a chronic, life-threatening, communicable, blood-borne viral disease, affecting up to five million individuals in the United States. It can lead to severe liver damage, infections, liver cancer, and death. Statistics from the Centers of Disease Control and Prevention indicate that up to 70 percent of those with HCV will develop chronic liver disease, 20 percent will develop cirrhosis, and 5 percent will develop liver cancer.

Some insurance companies in Florida either provide no coverage for all of the new generation of Hepatitis C drugs or price the patient cost-sharing so high, including deductibles in the thousands of dollars, that the drugs are inaccessible to many Qualified Health Plan enrollees. Some plans place the drugs on the highest cost-sharing tier (e.g. 50 percent co-insurance). The insurance companies may also require prior authorization in a manner directly inconsistent with the definitive standards of treatment, or limit the quantity of drugs available to the patient.

The insurance companies' actions discourage those with HCV from enrolling in their plans, thereby discriminating against those with a pre-existing medical condition. According to the Affordable Care Act and federal regulations, insurers cannot use discriminatory practices to deny coverage for treatment or discourage patients from enrolling in plans based on a medical condition

AfPA and The AIDS Institute urge Insurance Commissioner Kevin McCarty and his to-be-named replacement to take action to make sure Florida insurers are acting in accordance with federal laws and regulations and not engaging in discriminatory practices, effectively denying Hepatitis C patients access to new cures.

"For many patients living with Hepatitis C, new groundbreaking medications mean hope of being cured. Unfortunately, many Florida insurance companies are effectively denying treatment to eligible patients because of costly co-pays and lengthy prior authorizations," said Eliot Godofsky, MD., a member of the Alliance for Patient Access. "These practices, which only look out for the bottom line of insurance company profits, are not in accordance with federal law and the Affordable Care Act. We urge Commissioner McCarty to examine the practices of Florida insurers relating to Hepatitis C coverage so eligible patients get the necessary and proper treatment."

Added Michael Ruppal, Executive Director of the AIDS Institute, "The ACA law and federal regulations are very clear. Plans cannot place every drug in a class on the highest tier, and they cannot charge excessive patient cost-sharing or institute prior authorizations inconsistent with clinical treatment standards. To do so is pure discrimination."

To read the letter to Insurance Commissioner Kevin McCarty, click here.