A Washington D.C. non-profit has filed a lawsuit against Houston-based health insurance company Community Health Choice, alleging that the organisation discriminates against people with HIV.
Community Health Choice is a non-profit organisation in Houston that has provided Medicaid coverage to low-income families since its inception in 1997. The lawsuit, filed on September 26, alleges that the organization has charged high co-payments for medications and has included nearly all HIV medications in its most expensive health plan.
Community Health Choice did not respond to requests for comment.
The complaint by the Washington-based nonprofit HIV+Hep Policy Institute is addressed to the Centers for Medicare and Medicaid Services, a federal agency that administers Medicare benefits to providers nationwide.
The institute is asking the centre to take action against Community Health Choice for offering “substandard and discriminatory plans that violate the Affordable Care Act and its implementing regulations”. It is also asking the centre to review health plans with designs that discriminate against individuals.
“It’s like going back to the dark ages of HIV treatment,” said Carl Schmid, executive director of the institute.
Community Health Choice offers Premier and Select health plans on the Texas marketplace. The Institute argues that both plans have formularies that restrict access to necessary HIV treatment medications, with 36 out of 107 HIV drug formulations listed as not covered in the Premier plan and 54 out of 107 not covered in the Select plan.
“They cover these drugs, but what they are doing is putting every HIV drug on the highest tier,” Schmid said.
In addition, the drugs that are covered are “outdated generic formulations” and some are discontinued, he said.
The complaint is not the first of its kind from the non-profit HIV awareness organisation. In December, it filed a complaint against North Carolina Blue Cross/Blue Shield for placing nearly all HIV drugs, including generics, on the highest cost-sharing tiers.
The institute also referenced a similar discrimination complaint filed against Community Health Choice in 2016 by Harvard Law School’s Center for Health Law and Policy Innovation. The 2016 complaint, filed with the Office for Civil Rights at the US Department of Health and Human Services, asks the department to “end the insurer’s discriminatory practices”.
Both complaints refer to the Affordable Care Act, which states that no person shall be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health care program or activity that enters into an “insurance contract” with the federal government.
By the end of 2020, more than 100,000 Texans had been diagnosed with HIV, an increase of 13 percent over the past five years, according to the Texas Department of State Health Services.
