OIR to Review Charges of HIV Rx Drug Discrimination in ACA Plan Filings

The Florida Office of Insurance Regulation (OIR) is reviewing ACA plan filings that were due on May 15 to determine whether there is discrimination in coverage of HIV prescription drugs under the plan formularies.  In a memo (attached) issued by OIR on March 25, OIR directed insurers to refer to the benchmark plan offered by Florida Blue.  Last year, OIR brought a market conduct investigation against several of the large health plans but later reached voluntary settlement agreements with those plans. The investigation was initiated as a result of complaints brought to OIR by the AIDS Institute and AIDS Foundation, who alleged that some of the insurers put all HIV drugs on the highest tier and charged the patients co-insurance, which can be above $1,000 a month.  OIR warned that it would deem plans discriminatory if the tiered formulary of HIV/AIDS medications was not at least as favorable as the Florida’s benchmark plan, which limits patient co-pays to $40, $70, or $150 per 30-day supply, depending on the medication.

PPACA Notice to Industry: .pdf