- In May, the AIDS Institute and the National Health Law Program filed a complaint with the HHS's Office for Civil Rights in Florida, accusing four insurers of discriminating against HIV-infected individuals—a direct violation of the Affordable Care Act.
- Cigna and three other companies, including CoventryOne, Humana, and Preferred Medical Plan, were accused of using a variety of tactics to limit access and off-load costs onto HIV patients.
- Under the settlement, patients' out-of-pocket expenses for HIV drugs will be capped at $200, and patients will have access to both generics and branded drugs.
Advocates have accused Cigna and three other insurance companies of using a variety of tactics to limit access and coverage for critically needed HIV therapies, including placing generics on the highest payment tier for midlevel or "Silver" plans, which results in patients having to pay up to 40% of the cost of the drug.
What's more, for patients taking more expensive branded medications, costs could run as high as $2,750. Now that a settlement is in place, out-of-pocket costs are limited to $200 starting in 2015—including the highest-cost branded HIV drugs, such as Complera, Atripla, and Stribild (all from Gilead).
In addition, all generic HIV drugs will now be categorized as lower-cost generic-tier drug, just like other generics. Cigna did not admit any wrongdoing, but chose to comply with certain changes in order to avoid litigation.