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Cigna Agrees To End Controversial HIV/AIDS Drug Program

LAW360.COM

Cigna Health and Life Insurance Co. on Thursday agreed to remove certain HIV/AIDS medications from a list of drugs that must be obtained through mail order, setting a proposed nationwide class action in Florida that alleged the list was discriminatory.

In an agreed-upon motion to end the suit, Cigna said it has addressed the concerns raised by the anonymous class representative, who claimed Cigna routinely told enrollees that specialty drugs used to treat HIV and AIDS can only be ordered at a pharmacy or pay out-of-pocket for their medications.

"Defendants have agreed, intere alia, to remove all non-injectable antirotroviral HIV/AIDS medications currently covered by Cigna from its list of medicaitons that must be obtained through mail order," according to the motion.

Additional details of the settlement were not made public.

The Tel-Drug program violated multiple anti-discrimination provisions of the Affordable Care Act, such as those that bar eligibility rules based on health conditions and exclusion based disability, according to the April complaint.

The insurer skirts Employment Retirement Income Security Act provisions by revoking enrollees' right to use community pharmacies, causing an elimination of benefits without a change in coverage, failing to provide a claims procedure for opting out of the program and failing to provide explanation of coverage, according to the lawsuit.

The program also runs afoul of the Americans with Disability Act because it only applies certain high costs to specialty medication designed to treat complicated disorders but permits the plaintiff and class members to continue to use their pharmacists of choice as an in-network benefit for other medications, the complaint alleged.

The class has an estimated 7,000 members, according to Jerry Flanagan, Consumer Watchdog's lead staff attorney. The plaintiff wants Cigna to establish an opt-out program and also seeks attorneys' fees.

Whatley Kallas LLP and Consumer Watchdog, which along with Podhurst Orseck represented the plaintiff, have teamed up before in similar lawsuits against United Healthcare Insurance Co., Anthem Blue Cross and Aetna Inc.

Cigna does not comment on pending litigation. Whatley Kallas did not respond to a request for further comment.

The plaintiff is represented by Aaron S. Podhurst, John Gravante III and Matthew Weinshall of Podhurst Orseck, Edith M. Kallas, Joe R. Whatley Jr. and Alan Mansfield of Whatley Kallas LLP, and Jerry Flanagan of Consumer Watchdog.

The case is Doe v. Cigna Health and Life Insurance Company et. al., case number 0:15-cv-60894, in the U.S. District Court for the Southern District of Florida.

--Additional reporting by Jeannie O'Sullivan. Editing by Patricia K. Cole.