Advocacy in Action: Holding Insurers Accountable

An update on our actions to ensure that all people living with HIV/AIDS with prescriptions for FDA-approved antiretrovirals have access to the full HIV treatment formulary.

San Francisco AIDS Foundation recently learned of a decision by UnitedHealthcare to reject the prescription from a person living with HIV access to a newly FDA-approved antiretroviral regimen, Stribild, with once-daily dosing. We wrote a letter asking the insurance company to reconsider this decision for this member and guarantee full access to future customers holding prescriptions for this medication.

Our letter said, in part, “We strongly endorse UnitedHealthcare and all other payers providing full and unfettered access to the complete formulary of FDA-approved antiretroviral drugs for the treatment of HIV. The population of San Francisco would be negatively impacted by any decision to curtail or limit access to newly approved therapies. Indeed, it is in the direct best interest of UnitedHealthcare and other payers to ensure that all effective HIV medications are available for consideration by clinicians as they develop the most appropriate treatment plans for their patients’ long-term health. We ask you to reconsider any actions that would restrict access to new HIV therapies and that you restore full access by people living with HIV/AIDS to the complete FDA-approved antiretroviral formulary.”

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We are happy to report that UnitedHealthcare responded quickly to our letter saying it is committed to providing access to all antiretroviral medications to anyone who requires them. They shared with us that in April, 2013, they sent out 6,000 letters to clinicians who had a history of prescribing Stribild notifying them that it was putting the drug on a pre-certification schedule. The letter reportedly details how clinicians must communicate with UnitedHealthcare to ensure that the member is not a candidate for a lower-cost regimen. UnitedHealthcare characterizes its pre-certification process as an educational tool for network prescribers to make them aware of lower-cost antiretroviral options.

While we thank UnitedHealthcare for the quick response to our letter and its reassurances that the pre-certification process is not intended as a barrier or impediment to new, easy-dosing antiretroviral medications, we remain concerned about the impact of pre-certification processes on prescribing habits of clinicians. Will concerns about additional paperwork, delays, and administrative time and resources deter clinicians from prescribing drugs that actually would be most effective and beneficial to consumers? We will monitor the situation and remind all insurance companies that we, as advocates for improved health outcomes, will always be watching over their practices and policies to ensure that the rights of all their members are protected.

TAKE ACTION: If your prescription has been rejected because of a pre-certification policy at your insurance company, or that of someone you know, there is something you can do. Contact your medical provider and write your insurance company to demand reconsideration of the rejected prescription. If you have problems getting a good result from your insurer, contact San Francisco AIDS Foundation or an advocacy organization in your area for assistance. We are committed to holding insurers accountable and keeping broad access to antiretrovirals available throughout the system. 

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