Aetna, Inc. and Coventry Health Care of Florida, Inc. are revising their HIV/AIDS drug formularies for individual health plan members; changes mean a majority of HIV drugs currently labeled as specialty drugs in the highest cost tier will be reclassified as either generic or non-preferred brand drugs and moved into the lower cost tiers.
TALLAHASSEE, Fla. – Florida Insurance Commissioner Kevin M. McCarty announced this week that Aetna, Inc. and Coventry Health Care of Florida, Inc. are revising their HIV/AIDS drug formularies for individual health plan members. The new change means a majority of HIV drugs currently labeled as specialty drugs in the highest cost tier of the drug formulary are being reclassified as either generic or non-preferred brand drugs and moved into the lower cost tiers.
Effective June 1, 2015, individual health plan members of these two insurers will be able to purchase oral HIV drugs as generic or non-preferred brands, resulting in reduced costs and better access to these important medications. This coverage will also extend to individual health plan members in 2016 and extend geographically throughout the United States, and not just in Florida, according to sources contacted at Aetna.
“It is great to see that the results of months of dialogue and advocacy among key stakeholders throughout the U.S. have yielded such positive results with an impact that could ultimately be far more significant if adopted throughout the industry,” said AIDS Healthcare Foundation Southern Bureau Chief Michael Kahane. The stakeholders involved in these negotiations included AIDS Institute, NHeLP, AIDS Foundation of Chicago, and AIDS Healthcare Foundation (AHF).
“Aetna and Coventry’s actions represent a high level of commitment and responsiveness to the needs of its members,” stated Commissioner McCarty. “I look forward to working with the other health insurance companies who have also committed to focusing their efforts on this important issue.”
“It is also important to note that Aetna/Coventry’s change from the specialty tier for these important life-saving drugs will provide more choice for the patients in that they will have the option to visit a brick and mortar pharmacy or can choose to receive their medication through mail order,” said AHF Southern Bureau Director of Legislative Affairs David Poole.. “We hope this decision will become a trend in the industry.”
Last year, the Florida Office of Insurance Regulation became aware of allegations that several health insurance companies may have been violating Florida law by placing all HIV/AIDS medications in the highest tier of their drug formulary. The Office performed an in-depth review of the allegations, met with the health insurance companies and reached agreements on this issue. The insurance companies agreed to implement interim measures to limit health plan members’ cost-sharing responsibility for HIV/AIDS drugs in the highest tier of their drug formularies; ensure prior authorizations or step therapy were not required for prescribed HIV/AIDs drug treatments; and look for long-term solutions that would better address the affordability and accessibility of HIV/AIDS medications.