Form Hhs-699 - Discrimination Complaint - Department Of Health And Human Services - Office For Civil Rights (Ocr) Page 5
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of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
This is a living document
that is updated as new research and treatment options become available. Under the Guidelines,
HIV clinicians are advised to consider multiple factors when making an individualized treatment
plan for their patients. The clinician should consider such factors as pill burdens, comorbidities,
and avoid adverse drug interactions. Single-tablet regimens are often preferred by providers and
patients for their simplicity of use and likelihood of adherence. Due to these considerations as
well as patient and provider choice, HIV treatments are not interchangeable. Requiring all patients
to begin with the least expensive treatment before providing coverage for newer more expensive
treatments is contrary to current federal guidelines, which calls for individualized treatment plans.
Despite the new prohibition against disability discrimination, there has been an alarming decrease
in coverage around necessary HIV treatment regimens concurrent with increased cost sharing.
CHLPI, with the assistance of the AIDS Law Project, conducted an analysis of the prescription
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drug formularies and cost structure for all silver-level QHPs operating in Pennsylvania in 2016.
The analysis found that all of UPMC’s silver-level QHPs exhibited discriminatory plan design in
the form of “adverse tiering” – placing the most common and up-to-date HIV medications in a
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coverage tier with a high co-pay or co-insurance.
Other plans available through the
Pennsylvania Marketplace offer enrollees living with HIV more medications in a range of tiers
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and cost-sharing structures.
The QHP drug benefits offered by UPMC impose overly cost-restrictive tiering which unduly
limits access to commonly used HIV medications. This adverse tiering discourages people living
with HIV from enrolling in UPMC’s health plans - a practice which unlawfully discriminates on
the basis of disability. For example, the Guidelines recommend clinicians prescribe one of several
front-line regimens for treating treatment-naïve patients. These treatment regimens utilize either a
single-tablet or a combination of drugs. Under all of UPMC’s silver-level QHPs, all
recommended front-line regimens require consumers to pay 50% co-insurance for all but one
medication (and that medication must be taken with two other medications that require 50% co-
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insurance).
This contrasts sharply with Aetna’s silver-level QHPs which cover all five regimens
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on tiers with co-pays of either $40 or $75.
V.
RELEVANT LAW
A. The Affordable Care Act’s Anti-Discrimination Protections
Prior to the ACA, health insurance companies routinely discriminated against people living with
HIV. Plans denied coverage to individuals with pre-existing conditions including HIV and could
exclude from their coverage treatment for those conditions. Additionally, insurance companies
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Panel on Antiretroviral Guidelines for Adults and Adolescents, Guidelines for the Use of Antiretroviral Agents in
HIV-1 Infected Adults and Adolescents, DEP’T OF HEALTH AND HUMAN SERVS., available at
https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf.
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Center for Health Law & Policy, Harvard Law School, “2016 Plan Analysis for Qualified Health Plans,” (2016),
available at
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Id. at 213-248.
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Id. at 11-12.
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Id. at 213-248.
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Id. at 14-25.
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