Consumer advocates argue in a complaint filed Tuesday that insurer Cigna Corp. is illegally forcing AIDS and HIV patients to either get their prescriptions through the mail or pay high prices. The suit is the latest in a series of disputes involving access to HIV drugs under benefit structures that hold down costs.
A Cigna spokeswoman said Tuesday the insurer does not comment on litigation.
The lawsuit alleges that Cigna is discouraging HIV/AIDS patients from using the insurer's health plans by requiring them to get their medications by mail or pay out-of-network or full price for them. The mail-order requirement violates the Affordable Care Act's provision requiring healthcare coverage to be available to all Americans regardless of their health, according to the lawsuit, which was filed by Consumer Watchdog and law firms Whatley Kallas and Podhurst Orseck on behalf of an unnamed Florida man.
The lawsuit is the fourth filed by Consumer Watchdog over similar situations with other insurers, Flanagan said. Two of the targeted insurers—Anthem Blue Cross in California and UnitedHealthcare—have already settled, agreeing to allow HIV/AIDS patients to opt out of the mail-order requirement. Neither Anthem nor UnitedHealthcare admitted to any wrongdoing as part of those settlements. A similar lawsuit against Aetna is ongoing.
HIV/AIDS patients need access to community pharmacists who know patients' medical histories and can work with them in-person to help detect potentially life-threatening drug interactions and side effects, some of which can only be observed visually, according to the lawsuit. Community pharmacists can also quickly give patients new drug regimens as their diseases progress and give advice and counseling, according to the lawsuit.
Also, requiring the drugs to be sent by mail puts patients' privacy at risk, the lawsuit alleges. For example, if patients live in apartment buildings or get medications delivered to their workplaces, neighbors or co-workers might begin to suspect they're sick.
“These issues go to the heart of Obamacare, of the Affordable Care Act, it goes to the heart of the promise that you can have health insurance regardless of your condition,” said Jerry Flanagan, a lead staff attorney at Consumer Watchdog.
This latest lawsuit also follows much discussion over whether health insurers have been discriminating more broadly against HIV/AIDS patients by charging them high costs for drugs.
Aetna recently decided to move HIV drugs from its costliest specialty tier to a lower-cost generic or nonpreferred tier for its exchange plans after criticism from consumer groups that called the old pricing discriminatory. Cigna and Humana also lowered cost-sharing on HIV drugs on their Florida exchange plans in response to a complaint consumer groups filed with HHS.
The CMS said in February that it would take a tougher stance toward potentially discriminatory practices in the drug benefits for exchange plans in 2016.
In January, the New England Journal of Medicine published a study that showed a quarter of all silver-level plans examined in 12 states using the federal insurance exchange put a common class of HIV medication in a tier requiring at least a 30% coinsurance or copayment.