AHF Commends Outgoing Florida Insurance Commissioner Kevin McCarty for Standing Up To Health Insurers On Behalf of HIV Patients

In News by AHF

Largest FL HIV service provider calls on successor David Altmaier to continue fighting discriminatory drug formulary pricing practices

Fort Lauderdale, FL (May 5, 2016) — AIDS Healthcare Foundation (AHF), the largest single, non-profit provider of HIV services throughout Florida, commends Kevin McCarty for more than 13 years of exemplary leadership as commissioner of the Florida Office of Insurance Regulation (FOIR). McCarty, who recently stepped down as commissioner, spearheaded regulations requiring insurers to limit patient cost-sharing for HIV medications in their Qualified Health Plans (QHPs). Similar to last year, state officials will continue to review the submitted 2017 QHPs for potential discriminatory formulary tiering related to HIV medications. Cost-sharing for HIV drugs is expected to remain limited to $40, $70, or $150 per 30-day supply, depending on the medication. One injectable medication will have a co-pay limit of $200.

In a new requirement, officials will also review formulary adequacy and adverse tiering for other chronic health conditions, including hepatitis C, breast and prostate cancer, rheumatoid arthritis, bipolar disorder and schizophrenia, diabetes, and multiple sclerosis. In addition, the state will review plans for discriminatory benefit implementation and medical management techniques.

“Working with Commissioner McCarty has greatly improved access to lifesaving medications for people living with HIV/AIDS in Florida,” said AHF Southern Bureau Chief Michael Kahane. “As AHF continues to provide care to the 10,000 patients we serve in Florida and address global issues of access and affordability of care, we applaud the Florida Office of Insurance Regulation for continuing to recognize that an insurer charging excessive co-insurance for certain chronic health conditions is discriminatory and harmful. Florida’s leadership taking proactive steps to stand up to insurers is an example for other states to follow.”

While a review of Florida’s 2016 QHPs reveals that most insurers are now limiting patient cost-sharing for HIV medications, the practice of some QHPs not covering all HIV drugs available or placing all HIV medications—including generics—in the highest formulary tier and charging consumers 30-50% co-insurance under the Affordable Care Act (ACA) had been previously identified as a major issue. It was also determined that six out of the nine major insurers offering QHPs in Florida are charging beneficiaries coinsurance as high as 20-50% for all or almost all hepatitis B and C drugs.

“We are thankful for Commissioner McCarty’s leadership for the past 13 plus years and look to his successor, David Altmaier, to continue to ensure that discriminatory insurance policies are prohibited and strong state and federal patient protections are enforced,” said AHF Director of Legislative Affairs David Poole.

According to recent statistics from the Center for Disease Control and Prevention (CDC), Florida ranks second in the nation for new HIV infections. AIDS Healthcare Foundation, whose southern bureau is based in Fort Lauderdale, operates 16 clinic locations across Florida, in addition to mobile testing units that provide on-going HIV testing in communities throughout the state. To locate AHF Healthcare Centers, visit www.hivcare.org.

Image: Peter Andrew Bosch, Miami Herald | [email protected]

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