Insurer agrees to add HIV drugs after discrimination complaint filed

Harvard Pilgrim Takes Action in Maine while Cases Pending in Other States

In response to a discrimination complaint filed last month by the HIV+Hepatitis Policy Institute against health insurer Harvard Pilgrim for marketing plans that discriminate against people living with HIV, Maine’s Insurance Superintendent announced yesterday that the insurer will add Biktarvy, the most widely prescribed HIV treatment in the country, along with four other drugs to ensure it is meeting national HIV treatment guidelines.

In a press release Insurance Superintendent Bob Carey stated, “I welcome action taken by Harvard Pilgrim to reverse its initial decision to exclude these drugs—a decision made after the Bureau of Insurance pushed for this change. I also appreciate the work that health care advocates, in particular the HIV+Hepatitis Policy Institute, and health care providers played in bringing this matter to our attention.”

“While this action is certainly welcome, the fact remains that Harvard Pilgrim removed lifesaving HIV drugs from its coverage formulary, disrupted the treatment of people living with HIV, and violated the ACA’s nondiscrimination protections,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “This demonstrates the need for greater oversight of the health insurance industry and enforcement of the safeguards in place to protect patients against the abuse of insurers.”

HIV+Hepatitis Policy Institute also filed similar complaints against Harvard Pilgrim in the States of Rhode Island and New Hampshire.  It is unknown if the insurer will correct its health plans in those states. Rhode Island Office of the Health Insurance Commissioner came to the opposite conclusion from Maine on the adequacy of Harvard Pilgrim’s drug coverage. It appears that Rhode Island is using outdated review tools provided by the federal government agency charged with overseeing health plans.

HIV+Hep is also awaiting responses to its recent ACA discrimination complaints filed in Minnesota and Iowa against Medica for not covering national guideline-recommended treatments and placing all HIV drugs on the highest cost-sharing tier. HIV+Hep has also filed a complaint with CCIIO against Community Health Choice Texas for not covering HIV drugs in accordance with national treatment guidelines.

Katie Rutherford, executive director of Frannie Peabody Center in Portland, who joined in the complaint commented, “We are so grateful to Superintendent Carey and the Maine Bureau of Insurance for their diligence with their investigation and their strong stance in support of people living with HIV in Maine. Their decision, along with the voices of advocates, providers and community members reinforces the critical systems we rely on to ensure access to quality care moving forward.”

Maine’s HealthReach Community Health Centers, MaineGeneral Medical Center, Consumers for Affordable Health Care, and Dr. Stephen Rawlings (Medical Director, MaineHealth Adult Specialty Care Gilman Clinic) also joined in the original complaint.

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The HIV+Hepatitis Policy Institute is a national, non-profit organization whose mission is to promote quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.