Complaints filed with the Maine Department of Insurance focus on coverage of HIV medications.
Maine, Maine — Complaints Maine Department of Insurance against Harvard Pilgrim Healthcare Proponents say the insurance plan discriminates against Maine residents living with HIV.
The complaint focuses on the carrier’s 2025 health plan, which does not cover several HIV medications, including the most widely prescribed treatment in the United States.
More than 20 years ago, HIV treatment was a nightmare that involved taking up to 20 pills a day.
Dr. Stephen Rawlings said, “One pill once a day was once a dream. And we are now living that dream.”
Mr. Rawlings treats patients with HIV and is the medical director of Gilman Street MaineHealth Adult Specialty Care and MaineHealth Infectious Diseases. He says today’s treatments make HIV undetectable in the blood. The most popular treatments are Viktarvi, Patients can swallow one tablet once a day.
“Fifty percent of people with HIV are taking HIV, and HIV is controlling the infection,” Dr. Rawlings added.
But this fall, about 100 Pilgrim Healthcare patients were notified that the Maine 2025 plan would cover only two of the four drugs recommended in national treatment guidelines.
This includes the removal of Biktarvy, the most widely prescribed HIV treatment in the country.
Because of the out-of-pocket costs, some patients must find alternative treatments or change carriers. Time is running out. Registration deadline is Sunday.
“Cash prices for some medications range from $4 to $8,000 per month,” Dr. Rawlings explained.
Dr. Rawlings is one of several Maine doctors who signed a discrimination complaint sent to the Maine Department of Health.
Submitted by HIV+Hepatitis Policy Research Institute Last month, the group accused Harvard Pilgrim’s 2025 plan of discriminating against people living with HIV in Maine.
Katie Rutherford is Franny Peabody Centerprovides resources and support to people living with HIV. She said about 1,800 people in Maine live with the disease. Their numbers are increasing, likely due to a lack of safe housing and other services. She thinks patients could step out of the gap if insurance coverage is reduced.
“If one insurance company can do this, what’s stopping other insurance companies from doing it, especially with respect to the Affordable Care Act?” Rutherford said.
“Current Harvard Pilgrim Health Plan members will continue to receive these HIV medications with no changes to their coverage,” Harvard Pilgrim spokeswoman Kathleen Makera told News Center Main in a statement. has developed an insurance coverage process for new and prospective Harvard Pilgrim members.” Please consider medication according to our continuity of care guidelines,” Makela said.
In a statement from the Maine Department of Health, Superintendent Robert Carey said the agency takes complaints seriously and is working to resolve the issue.
“We will also ensure that people with HIV and other diseases are not unfairly discriminated against or forced to change insurance companies to maintain treatment options,” Carey said. said.
Under Maine law, Dr. Rawlings and other health care providers can request a prescription exception if a treatment not covered by insurance is medically necessary. He hopes that doesn’t happen.
“Let’s keep these medications on the prescription so patients have access to them,” Rawlings said.
Maine Department of Health officials have not announced whether Harvard Pilgrim Healthcare will be required to cover HIV treatment plans next year. Similar complaints were filed in New Hampshire and Rhode Island.
For more local coverage, continue reading on the NEWS CENTER Maine+ streaming app.
Download the NEWS CENTER Maine mobile app for the latest breaking news, weather and traffic alerts.
