Issue:  Vol. 48 / No. 11 / 15 March 2018

Breaking: Kaiser takes HIV drugs off ‘specialty tier’

Kaiser Permanente will stop charging people more for HIV drugs and offering refunds beginning Friday, San Francisco Supervisor Scott Wiener told the Bay Area Reporter.

The health care provider was criticized after it came to light that it was charging people about 20 percent of the cost of their medications, rather than a flat copay. Larry Hickey, chief financial officer of Berkeley’s Steamworks bathhouse, said earlier this month that an employee came to him after being “hit with a $900 bill for one month’s supply” of HIV drugs.

(Kaiser will remove HIV medications from its "specialty tier." Photo: Rick Gerharter)

(Kaiser will remove HIV medications from its “specialty tier.” Photo: Rick Gerharter)

Wiener said at a meeting with Kaiser officials Thursday morning, February 19, “they informed me they are moving all the HIV drugs off the specialty tier effective [Friday] and they will be refunding people” for the higher amounts they paid.

Wiener offered strong praise for Kaiser’s move.

“Kaiser is a good actor in our community,” said the gay supervisor. “Kaiser is an institution that’s always been a core part of public health efforts in San Francisco and the Bay Area,” and the corporation “cares about community health. I think they took a step back and realized this was the right thing to do.”

Wiener noted “the broader issue” remains of Kaiser and other companies having a more expensive classification for any drugs.

“The whole issue of a specialty tier of drugs is a growing problem, that drugs that people need to be healthy are turning out to be exorbitantly expensive for people who can’t afford a $600 or $800 copay,” said Wiener. Kaiser’s move today is “an important step forward, but a broader step remains.”

He said he still plans to have a board committee hearing on specialty tiers within the next month.

It’s unclear whether Kaiser would have made the decision to take HIV medications out of the special category without the criticism generated by a B.A.R. story on the issue.

Wiener suggested giving the company the benefit of the doubt.

“This just started last month,” he said. “It’s not like this has been going on for years and years and it was somehow secret. It became public immediately.”

Kaiser “took a step back and realized this is not the way to go,” Wiener said. The health care provider “made the right decision here, and we should acknowledge that.”

Updated: Kaiser spokesman John Nelson said that the specialty tier was a new part of Kaiser’s coverage this year.

“We did not previously have a specialty drug tier in our commercials plans (we only had generic and brand tiers),” Nelson said in an email. “So in designing this benefit, we decided to adopt the model used by most Medicare plans (ours included) to determine which drugs would be placed in the specialty tier.”

Unfortunately, he explained, “the change resulted in the vast majority of drugs used to treat HIV being included in the specialty tier, meaning patients would be exposed to new cost-sharing requirements.”

“We will be moving quickly in the next several days to move the HIV drugs that we currently have on the specialty tier to the brand tier, effective immediately,” Nelson said. “This means these drugs will no longer require a coinsurance payment with each prescription, but rather will return to the fixed copayment already included in each members’ plan for brand tier drugs. Further, we will also develop a process to send refunds to those patients who received these drugs since January 1 and paid the higher, coinsurance amount, instead of the brand tier copayment amount. It may take us a few weeks to research, arrange and deliver the refunds to each affected member. We will contact members to let them know of this change.”

– reported by Seth Hemmelgarn

— Cynthia Laird, February 20, 2015 @ 7:00 am PST
Filed under: Uncategorized

RSS feed for comments on this post.

Comments are disabled at this time.

Follow The Bay Area Reporter
Newsletter logo
twitter logo
facebook logo