Fourth Florida insurer agrees to cap cost of HIV drugs

Fourth Florida insurer agrees to cap cost of HIV drugs

Kevin McCarty, Commissioner of the Florida Office of Insurance Regulation.

By Nicholas Nehamas, Miami Herald

The last of four Florida insurers blasted by AIDS activists for the high cost of their HIV drugs relented last week, saying it would cap what patients pay every month for four types of medication.

“We will voluntarily agree to set an out-of-pocket limitation of $200 per month on each of the following drugs: Atripla, Complera, Stribild, and Fuzeon,” Preferred Medical Plan CEO Tamara Meyerson wrote to Kevin McCarty, commissioner of the Florida Office of Insurance Regulation, in a Jan. 14 letter.

The other three companies — Coventry Health Care, Humana and Cigna — had earlier reached formal agreements with state regulators to lower their prices and to fill prescriptions without prior authorization for 2015.

Preferred did not violate Florida’s anti-discrimination laws, said Amy Bogner, a spokeswoman for the state’s insurance office.

An estimated 120,000 Floridians have HIV, and nearly half of them live in South Florida, according to state data.

The four Florida insurers were the focus of a federal civil rights complaint filed last May by The AIDS Institute, a non-profit group in Tampa. The complaint accused insurers of discriminating against people with HIV by making their medications too expensive — as much as $1,500 per month for drugs on some health plans offered in Florida last year.

The U.S. Department of Health and Human Services (HHS) is still investigating the complaint, according to spokeswoman Rachel Seeger.

Carl Schmid, deputy executive director of The AIDS Institute, said he was disappointed the state did not ask Preferred to sign a more extensive agreement.

“What’s in the letter is really nominal,” Schmid said. “It doesn’t even say how long Preferred has to abide by these terms.”

But David Poole, a spokesman for the AIDS Healthcare Foundation (AHF), which worked with state regulators on the drug pricing issue, called the letter “acceptable” and said all insurers should ensure antiretroviral medications are “accessible and not economically out of reach.”

The news comes as Gov. Rick Scott confirmed that he was seeking to replace McCarty, who has led Florida’s insurance regulator since 2003.

AHF yesterday sent a letter to the governor praising McCarty’s work on the pricing of HIV drugs.

“The actions of the commissioner and his staff assured … that public health in Florida would not suffer because of the restrictive actions the private insurance companies had instituted,” the letter said.

    This article was reprinted from Kaiser Health News with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a non-partisan health care policy research organization unaffiliated with Kaiser Permanente.