Aetna to lower costs for most HIV drugs after complaint

(Bloomberg)  -- Aetna Inc. has agreed to reduce out-of-pocket payments for most HIV and AIDS medicines after pressure from an advocacy group, revising coverage that had some patients paying $1,000 a month for the drugs.

Before the change, Aetna put almost all HIV drugs in its highest category of cost sharing, asking patients to pay as much as half the expense of high-priced medicines, according to the AIDS Institute. The health insurer will move the drugs into a category that will charge patients $5 to $100 after deductibles are met, the nonprofit institute said March 26. Cynthia Michener, an Aetna spokeswoman, confirmed the change.

Also see: Four insurers accused of high HIV drug prices

“Aetna’s announcement will help ensure that people living with HIV/AIDS throughout the country will have greater access to essential medicines at a more affordable cost,” says Michael Ruppal, executive director of the AIDS Institute. “However, there are still many other insurers who are charging patients excessive costs for their HIV medications.”

The announcement comes after the AIDS Institute and the National Health Law Program filed a complaint with the Department of  Health and Human in May 2014 alleging that Aetna, Humana Inc. and Cigna Corp. tried to steer HIV and AIDS patients away from plans offered in the federal insurance exchange in Florida by restricting coverage of HIV medicines. In mid-level “silver plans” offered in Florida, all three insurers required high out-of-pocket spending, the groups said.

Florida’s insurance commissioner, Kevin McCarty, said in a separate statement that he anticipates “working with other health plans who have also committed to focusing their efforts on this important issue.”

Nationwide change

Aetna’s co-payment changes will be effective June 1, and continue nationwide in the individual market through 2016, the AIDS Institute says. The Hartford, Conn.-based insurer is the third-largest in the U.S. by revenue.

The Affordable Care Act bars insurers from denying coverage to people who are sick. Advocates for people with costly illnesses, such as AIDS or cancer, have been concerned that insurers could construct benefit packages discouraging sick people from picking their products.

Carl Schmid, deputy executive director of the AIDS Institute, says the group will keep pushing insurers to lower costs nationally for treatment of the diseases. He says his group is also examining the expense of hepatitis C medications.

“There’s been some improvement, but not enough,” Schmid says. “We need the ACA to work for patients, and that’s our goal.”