Report Slams HMOs Over Limited Access
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Advocates for patients with HIV and AIDS say a newly released report by State Senator Jeffrey Klein is backing up their claims that HMOs are putting dollars ahead of health care. NY1's Rebecca Spitz filed the following report.Before Rosa Lozada found an insurance company to help her pay for her HIV medications, she says she was paying as much as $900 for one prescription.
"I went to my house and said how am I going to do it, how am I going to pay for this?" Lozada said.
And Rosa isn't alone.
State Senator Jeffrey Klein released a report Thursday, showing Latinos are among the New Yorkers whose insurance companies are limiting their access to HIV/AIDS medication.
Klein's office monitored the 12 most widely used HMOs in the state. It found they limit the number of allowable doses and block coverage of so-called single source drugs -- those which are patented, brand name medications with no generic equivalent.
"The problem we're seeing time and time again is that doctors are prescribing single source drugs because they know that's the medication their patients need to stay alive in many cases, yet the HMOs are not covering it," Klein said.
According to the Department of Health, as of 2007, there were nearly 120,000 people in New York City living with HIV or AIDS. African-Americans and Latinos have the highest rates of infection -- 45 and 31 percent, respectively. Advocates say all of them deserve the best treatment, no questions asked.
"This should be as simple as a doctor telling a patient what they need to get better and a patient being able to get it from their health insurance company, period. When New Yorkers are not served well by their HMOs, everyone suffers," said Empire State Pride Agenda Executive Director Alan Van Capelle.
Doctors are among those most outraged by the findings in Klein's report. They say denying the African-American and Latino population the medication it needs forces patients to make decisions that are potentially life threatening.
"With HIV, it's a little different in that it's lifelong therapy and it's so important that patients are adherent to their medications," said said Dr. Antonio Urbina of the St. Vincent's Comprehensive HIV Center. "If not, what happens is they can develop resistance and the medication will stop working."
NY1 reached out to several insurance companies named in Klein's report, including Aetna and Cigna, for a response. As of late Thursday, neither company responded with any kind of statement.