This week, Coventry Health Plan announced that it would dramatically reduce out-of-pocket costs for HIV medications in individual plans purchased on Health Insurance Marketplaces established under the Affordable Care Act (ACA). The change comes in response to requests from advocates, including AIDS Foundation of Chicago (AFC) and AIDS Legal Council of Chicago (ALCC).
“We thank Coventry for recognizing that placing all HIV medications on the highest cost-sharing tier makes it nearly impossible for most people with HIV to afford life-saving medications,” said John Peller, president/CEO of AIDS Foundation of Chicago. “Coventry is being a good corporate citizen by voluntarily improving their coverage policy.”
Thanks to this change, instead of paying as much as $1,500 a month for medications, people with HIV will pay a much more reasonable cost of $5-$100 per prescription.
In December 2014, AFC released an analysis of plans offered by Coventry and other companies on the Illinois Health Insurance Marketplace. AFC found that Coventry and two other plans placed all commonly-used HIV medications on specialty tiers, making medication extremely unaffordable for individuals living with HIV.
AFC and ALCC sent a letter to Coventry urging the company to immediately amend their formulary to make HIV medications more affordable. AFC and ALCC believe placing all HIV medications on specialty tiers may deter people living with HIV from enrolling and may be discriminatory.
“We deeply appreciate the open dialogue we had with Coventry. We shared our concerns, and they listened and talked with us,” said Tom Yates, Executive Director of AIDS Legal Council of Chicago. “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.”
In 2014, National Health Law Program and AIDS Institute filed a federal civil rights complaint against Coventry and three other insurance companies offering plans in Florida. The complaint alleged that Coventry and the other plans discriminated against people with HIV by putting all HIV medications on the highest co-insurance tier. In a settlement brokered by the Florida Department of Insurance, Coventry admitted no wrong-doing but significantly reduced out-of-pocket costs for HIV medications for its Florida members. AIDS Healthcare Foundation also played a role in the Florida policy change.
“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,” continued Peller. “Such coverage policies impede access to care for people with HIV and may be discriminatory.”
Coventry’s new HIV drug coverage policy will be effective June 1, 2015.