Blue Cross & Blue Shield Accused of Discrimination by HIV Advocates

Two separate complaints have been filed against the North Carolina Blue Cross and Blue Shield claiming discrimination against HIV patients.

The suits, filed by the HIV+Hepatitis Policy Institute and the North Carolina AIDS Action Network, claim the insurance company places almost all HIV drugs, including generic PrEP, on the highest drug tier. This effectively causes those living with and vulnerable to HIV to pay the excessively high costs for their drugs.

With the complaints respectively filed to the North Carolina Department of Insurance and the Office of Civil Rights at the U.S. Department of Health and Human Services, the groups are urging for immediate enforcement on the matter.

In both 2022 and 2023, the health insurer plans to place the majority of HIV medication on the highest cost-sharing, known as “adverse tiering.” This practice violates the Affordable Care Act patient protections and places almost all HIV antiretroviral medications on Tiers 5 and 6, which are the highest-cost prescription medications. This also includes the only generic drug used as PrEP, the preventative HIV medication.

Patients needing HIV medication are looking at a 50 percent co-insurance (the percentage of costs of a covered health care service incurred once someone pays their deductible) after a $3,000-7,000 deductible.

“The ACA’s non-discrimination provisions are very clear,” said executive director of the HIV+Hepatits Policy Institute Carl Schmid in a press release. “This is a clear effort to dissuade people living with and at risk of HIV from enrolling in these plans and jeopardizes people’s health and the public health.”

The interim executive director of the North Carolina AIDS Action Network, Veleria Levy, echoed the statement and highlighted the stigmas and barriers HIV positive patients already face.

Failure to address this discrimination will worsen health inequities, especially among minorities, Schmid and Levy say.