The advocacy group Consumer Watchdog filed a lawsuit (opens in new tab) Friday against Aetna in federal court in San Diego, claiming the insurer discriminated against patients with HIV.
Because Aetna requires HIV patients to obtain medications exclusively through its own mail-order pharmacy–with early refills of the drugs not permitted–Consumer Watchdog believes the insurer's policy violates the Affordable Care Act, which states insurers cannot discriminate against individuals with certain medical conditions (opens in new tab), the New York Times reported (opens in new tab).
The Department of Health and Human Services proposed a rule this fall that would require insurers to offer an alternative to mail-order pharmacies. HHS believes that mail-order pharmacies discriminate against those without a fixed address, or aganst people who wish to keep their condition private, noted the Times.
The insurance industry claims that mail-order pharmacies keep down costly premiums, and can better serve and keep track of patients with serious conditions. A spokeswoman for Aetna told the Times that the policy is consistent with industry standards.
Meanwhile, the Obama administration said Monday it would investigate whether insurers do, in fact, discriminate against those with chronic conditions, according to (opens in new tab) a second Times article.
The administration will look at insurers who sell on the federal marketplace and determine "estimated out-of-pocket costs associated with standard treatment protocols for specific medical conditions using nationally recognized clinical guidelines."
Around the industry, other advocacy groups urge HHS to better enforce the Affordable Care Act's anti-discrimination policy. In a letter (opens in new tab) sent Friday to HHS, a coalition of 279 patient groups wrote, "We call on [the Centers for Medicare and Medicaid Services] and others to begin to enforce the ACA non-discrimination provisions and to issue regulations that further define what discrimination is."
This is not the first time insurers have been on the hot seat for violating discrimination policies. Just last month, Cigna announced it will redesign the HIV prescription drug benefits on its exchange plans sold in Florida next year (opens in new tab) in response to a complaint accusing the company–and three others–of discriminating against customers with HIV and AIDS.
For more:
– here's the Consumer Watchdog lawsuit (opens in new tab) (.pdf)
– read the first Times piece (opens in new tab)
– check out the second Times piece (opens in new tab)
– here's the patient groups' letter (opens in new tab) (.pdf)
Related Articles:
Payers respond to discrimination complaint involving HIV/AIDS patients (opens in new tab)
Do exchange plans discriminate against AIDS/HIV patients? (opens in new tab)
High cost of drugs price HIV and AIDS patients out of health insurance policies (opens in new tab)
UnitedHealth to lift mail-order requirement for HIV/AIDS meds (opens in new tab)
