The advocacy group Consumer Watchdog filed a lawsuit 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, the New York Times reported.
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 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 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 in response to a complaint accusing the company–and three others–of discriminating against customers with HIV and AIDS.
Payers respond to discrimination complaint involving HIV/AIDS patients
Do exchange plans discriminate against AIDS/HIV patients?
High cost of drugs price HIV and AIDS patients out of health insurance policies
UnitedHealth to lift mail-order requirement for HIV/AIDS meds