Harvard lawsuit alleges insurance companies engaged in discriminatory pricing practices against HIV patients

by Eric Pearson

A lawsuit against insurance companies in eight states has been filed, alleging that insurers are engaging in discriminatory practices against patients with HIV or other conditions by making the drugs to treat these illnesses unavailable or unaffordable. The lawsuit, filed by Harvard Law School’s Center for Health Law and Policy Innovation, alleges that these discriminatory insurance practices may have caused some HIV patients to be deprived of necessary treatment or required them to pay high out-of-pocket costs for essential medications.

The Harvard lawsuit was filed against seven insurance companies in eight states. The insurance plans involved in the lawsuit include Humana plans in Alabama, Georgia, Illinois, Louisiana, Tennessee, and Texas; Cigna plans in Georgia, Tennessee, and Texas; Highmark, Independence Blue Cross, and UPMC insurance plans in Pennsylvania; Community Health Choice plans in Texas, and Anthem Blue Cross Blue Shield plans in Wisconsin.

According to the lawsuit, the insurance companies named in the complaint engaged in practices such as refusing to cover single-tablet drug regimens – in which different drugs are combined in one pill – or placing drugs that treat HIV in the highest cost tiers. As a result, HIV patients with these insurance plans were forced to pay significantly higher costs in order to receive drugs necessary to treat their condition.

Although the Affordable Care Act and other federal laws explicitly prohibit insurance discrimination based on factors such as age, race, gender, sexual orientation, or pre-existing conditions, proving discrimination such as the kind alleged in the Harvard lawsuit can be more difficult.

To prove its claims against the seven insurance companies named in the lawsuit, Harvard researchers worked with AIDS groups in several states to examine hundreds of silver-level insurance plans sold in health care marketplaces. Researchers sought to determine whether the insurers’ drug formularies would allow the six drug treatment regimens currently used to treating people who were recently diagnosed with HIV. Researchers also sought to determine the cost-sharing requirements for these plans to determine if the treatment regimens would be affordable for insured individuals.

The researchers found that in many cases, the plans which were named in the lawsuits charged placed some or all of the drugs in the treatment regimens in the highest cost sharing tier, making them significantly more expensive for patients. In other cases, the insurance plans failed to cover single-tablet regimens, making it more difficult for patients with HIV to effectively receive treatment.

A 2016 study by the health care consulting company Avalere Health found that, overall, marketplace insurance coverage for high cost conditions such as cancer, HIV, and multiple sclerosis has improved in recent years. Although the Harvard lawsuit focused on discriminatory practices related to HIV drug treatments, the school says that the lawsuit may benefit other marketplace-insured patients with conditions requiring high-cost treatments.

Bad Faith Insurance Claims Handled by Heygood, Orr & Pearson

If you or a loved one have been the victim of discriminatory practices by an insurance company over the cost of prescription medications or medical treatments, you may be eligible to file a lawsuit. The first step in taking legal action is to speak with an experienced attorney who can advise you regarding your legal rights and guide you through the process of filing a case.

The lawyers at Heygood, Orr & Pearson believe that individuals and companies who find themselves in the unenviable position of having an insurance company refuse to treat them fairly and reasonably The lawyers at Heygood, Orr & Pearson have filed hundreds of lawsuit on behalf of insurance customers whose claims were wrongfully denied by an insurer.  We have successfully represented businesses of all sizes, from small “mom and pop” businesses to some of the largest corporations in the world.

Heygood, Orr & Pearson also has the financial resources to handle bad faith insurance cases from start to finish. In many instances, our firm has invested hundreds of thousands of dollars in a case in order to take it to trial. Regardless of the type of claim, the size of the client or the complexity of the dispute, Heygood, Orr & Pearson has the legal ability, financial wherewithal and level of commitment necessary to successfully represent the interests of any commercial client.

For more information about filing a bad faith insurance lawsuit, contact the lawyers at Heygood, Orr & Pearson for a free legal consultation about your case. You can reach us by calling toll-free at 1-877-446-9001, or by following this link to our free case evaluation form and answering a few brief questions to get started.