AIDS Foundation of Chicago ( AFC ), on Sept. 6, filed a formal complaint with the U.S. Department of Health and Human Services' Office for Civil Rights ( OCR ) against Humana, charging that the insurance giant routinely denies coverage for or limits access to HIV medications through prohibitively high cost sharing requirements.
AFC filed the complaint in partnership with Harvard Law School's Center for Health Law and Policy Innovation ( CHLPI ), which has partnered with a number of health organizations for complaints against insurance companies in other states.
According to the complaint, Humana offers policies on the Affordable Care Act marketplace but regularly refuses to cover lifesaving medications and requires significant cost-sharing from patients with certain conditions such as HIV. Insurance companies on the marketplace cannot refuse to exclude policyholders because of pre-existing conditions.
"We're calling for change because we cannot codify discriminatory practices by insurers," said Ramon Gardenhire, Vice President of Policy and Advocacy at AFC, in a statement. "This landmark effort will protect insurers who offer reasonable access to HIV medications, promote more consistent coverage patterns by insurers, and support efforts to ensure that people living with HIV and other chronic diseases can thrive."
"Filing this complaint is a step toward making the ACA work better," added AFC CEO and President John Peller. "We're taking this action to ensure that the Affordable Care Act remains affordable. The vast majority of health care plans in Illinois provide good and affordable coverage for people living with HIV. Unfortunately, there are some bad actors that need to be addressed and returned to compliance for the sake of health equity across the U.S."
According to the complaint, a Humana individual plan enrollee taking the medication Triumeq would pay more in three months than an enrollee with diabetes would pay in an entire year for all prescriptions and medical services.
"CHLPI and AFC are using the OCR process to shine a light on discrimination occurring under the cloak of supposedly neutral insurance plan benefit design. When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication, it violates federal law," said Robert Greenwald, CHLPI's faculty director and clinical professor of law at Harvard Law School. "These are landmark Complaints that will benefit everyone looking to receive equitable, comprehensive health care through the marketplaces by helping to define anti-discrimination law at a time when insurers are covering less and less."
The complaint comes as part of a larger call for accountability for coverage, or lack thereof, in the federal insurance marketplace.
"Health care that people cannot afford is about as useful as no health care at all," said Gardenhire. "Left unchecked, these practices will drive people living with HIV out of the health insurance market, essentially returning them to a pre-Obamacare coverage gap."