Announcement sets stage for better HIV medication coverage in 2015
CHICAGO — In a statement issued on May 23, Illinois Department of Insurance (DOI) Director Andrew Boron informs insurers that the department will not permit health insurance plans that discriminate against people living with HIV/AIDS to be sold on the Illinois Health Insurance Marketplace in 2015.
According to the statement, “prohibition on discrimination applies equally to all health conditions, including but not limited to individuals with HIV/AIDS.”
“Thanks to Governor Pat Quinn and DOI Director Andrew Boron, Illinois is the first state in the nation to issue an explicit prohibition on discrimination against people with HIV in health insurance marketplace plans,” said John Peller, interim president/CEO for AIDS Foundation of Chicago (AFC). “This move serves as the latest example of the ways Governor Quinn has served as a watchdog for people living with HIV.”
AFC and AIDS Legal Council of Chicago (ALCC) received pro bono assistance from law firm Jenner & Block to illustrate possible gaps in coverage for people living with HIV/AIDS in current health plans available through Illinois’ insurance marketplace, which was established by the Affordable Care Act. AFC released a report in March 2014 that revealed the extremely high cost of HIV medications for marketplace plans and indicated that some plans are not covering certain HIV drugs at all.
“Health plans endanger the lives of people with HIV when they deny medications. The DOI’s statement underscores that this practice is discriminatory,” said Thomas D. Yates, executive director for AIDS Legal Council of Chicago.
“This is a major step toward fulfilling the Affordable Care Act’s promise to end discrimination by health insurers against people with pre-existing conditions, including HIV/AIDS,” said Daniel A. Johnson, a Jenner & Block associate. Johnson, along with colleagues Christopher C. Dickinson and D. Matthew Feldhaus, formulated a comprehensive report for the DOI addressing insurance companies’ positions on HIV/AIDS treatment (available here).
According to Jenner & Block’s report to the DOI, insurance discrimination against people living with HIV/AIDS can come in many forms, including burdensome restrictions on HIV/AIDS drug coverage.
The statement directs insurers to adhere to recommendations by the Department of Health and Human Services on “recommended” and “alternative” drug regimens for HIV/AIDS treatment.
According to the department’s statement, other measures insurance companies can take that might be found to be discriminatory against HIV-positive enrollees include forcing them to use less effective HIV drugs before moving on to more effective drugs (”step therapy”) and requiring an enrollee to seek pre-authorization for every refill of HIV drugs after the insurer has approved the initial filling.
“The Affordable Care Act is built on the concept of equal access to quality medical coverage for all Americans, and that includes people living with HIV/AIDS,” said Peller. “The action by the Department of Insurance is a strong step towards making that concept real. We look forward to working with the department and insurers to make sure people with HIV get the coverage they need to stay healthy on the Illinois Health Insurance Marketplace in 2015.”
