San Francisco Supervisor Scott Wiener is calling for a hearing on Kaiser Permanente making people who are living with HIV pay more for their drugs, Wiener announced today (Friday, February 13).
People living with HIV/AIDS and advocates are concerned about increased costs for medications since Kaiser has begun requiring people to pay a percentage of the cost of their drugs, rather than a copay amount. Other companies are reportedly doing it, too, but Kaiser has received the most attention.
“It’s very troubling to me to hear that Kaiser is dramatically increasing what people have to pay for HIV medications,” said Wiener, who’s heard it “may not be limited to Kaiser,” and there may be a “broader trend of reclassifying HIV meds as ‘specialty drugs.’”
Either way, “it needs to end. People need to have more access to HIV medications, not less,” said Wiener.
One local company that uses Kaiser to provide health care coverage to employees is Steamworks, which runs a bathhouse in Berkeley and has an office in San Francisco. Larry Hickey, Steamworks’ chief financial officer, said recently that an employee came to him after being “hit with a $900 bill for one month’s supply” of HIV drugs.
Wiener referred to the city’s “Getting to Zero” efforts, which is aimed at ending local HIV transmissions altogether.
“The affordability of HIV medications is a core part” of the initiative, he said. Among other concerns, “people who are positive need to have access to HIV medication so they can stay healthy and so they can suppress their viral load,” since that makes people “much less likely to transmit the virus to anyone else.”
“In San Francisco, we can’t have it that the cost of HIV medication is exploding. …We can’t allow that to happen,” said Wiener.
John Nelson, a spokesman for Kaiser Foundation Health Plan, recently said in an email exchange with the Bay Area Reporter that Kaiser made the change “in order to align more closely with the standard plan designs offered in California.” He said, “This means that outpatient specialty drugs will be subject to a coinsurance payment,” which is “a percentage of the total cost” paid after deductibles.
“Coinsurance amounts range from 10 percent to 40 percent of specialty drug costs, depending on a member’s plan,” said Nelson
Wiener said that he’s “a big fan of Kaiser” and called the company “a terrific organization.”
“Kaiser does so many great things around patient care and broader issues of public health, so I look forward to working with Kaiser to try to resolve this,” he said.
Officials from the company will be invited to the hearing, which will likely be heard at a supervisors’ committee “within the next month,” said Wiener. He doesn’t know yet which panel that will be.
Kaiser is one of two insurance providers for city employees. Blue Shield is the other. Wiener said he’s inquiring whether Kaiser’s specialty tier is impacting city workers.
Asked whether it would affect Kaiser’s status as a provider for the city if the company doesn’t change its policy, Wiener said, “It’s very premature to say anything about that. I’m a big fan of Kaiser, and I really want to work with them to resolve this.”
Anne Donnelly, health care policy director for the San Francisco-based Project Inform, said other large plans “have most of the HIV drugs tiered at a reasonable level.”
A concern is if that Kaiser leaves the pricing change in place, others may follow.
“What’s worrisome about Kaiser is they’re a pretty big plan,” said Donnelly. “If they’re doing this, it does seem like a race to the bottom.”
Donnelly noted Covered California, the state’s health insurance exchange, has a working group looking at specialty drugs.
“We’re looking at several classes of drugs,” including those related to HIV and hepatitis C, said Donnelly. “What we’re trying to determine is if there’s something we can come to as a group that we can recommend or require in the 2016 plan offering” through Covered California.
“I am hopeful that we can come up with something that is less discriminatory than what we currently have,” she said. Donnelly and others are hoping to meet with Kaiser, but “I just don’t know how much leverage we have. … The decision was made at the national level.”