Cigna Health and Life Insurance Co. has agreed to provide some lower-cost drugs for HIV/AIDS patients in Florida who sign up for health insurance coverage for 2015.
According to a consent order with the Florida Office of Insurance Regulation, Cigna will cap a patient’s contribution for Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate) Complera (emtricitabine/rilpivirine/tenofovir), Stribild (elvitegravir, cobicistat/emtricitabine/tenofovir), and Fuzeon (enfuvirtide) at $200 per month.
The health insurance company had included all HIV drugs on its specialty tier of its formulary for its 2014 qualified health plans, which included generic versions of widely prescribed antiretrovirals.
A complaint was filed in May by the AIDS Institute and The National Health Law Program, alleging “that coinsurance for this [specialty] tier was forty to fifty percent, making the access to these medications financially prohibitive for many of Cigna’s enrollees or potential enrollees,” according to the consent order.
In addition, Cigna required HIV/AIDS patients to obtain prior authorization for all refills of the medications and limited the amount of supply to 30 days. “The complaint alleged that this benefit design discriminated against people living with HIV and AIDS, and deterred people [with HIV/AIDS] from enrolling in the health plans, in violation of federal law,” the document stated.
In a report by the Miami Herald/Kaiser Health News, Carl Schmid, deputy executive director of the AIDS Institute, was pleased with the outcome of the consent order, noting that “Cigna recognized they had problems with the way they designed their plans and how it affects people with HIV.” However, Schmid thought more HIV drugs should be included in the non-preferred generic tier with the $200 monthly cap. He also noted that a 90-day supply of these drugs should be available, instead of the 30-day supply.
Cigna noted in the consent order that it would continue to work with Florida’s Office of Insurance Regulation to address the issue of subscriber prescription medication access for plan years starting January 1, 2016, the consent order stated.
Cigna denied “all of the allegations in the complaint filled in May with the Office of Civil Rights.”