Health Insurers May be Finding New Ways to Discriminate Against Patients


As originally published in the Washington Post, January 28, 2015:

One of the greatest promises of the Affordable Care Act is that if you are sick or get sick, health insurers can no longer charge you more or avoid covering you altogether. They have to provide coverage to anyone who wants it, and they're not allowed to cherry pick healthier customers over sick customers.

But patient groups say they've spotted an alarming trend of some health insurance plans designing drug benefits to purposefully keep out sicker, costlier patients. It's currently the subject of a federal complaint, and a new study offers evidence this is happening across the country.

Here's how advocates say this works. Rather than reject coverage for sick patients altogether, some insurers are placing high-cost medications for chronic conditions into the highest-priced tiers of the drugs they cover, which would force patients to pay potentially thousands of more dollars out of pocket for essential medications.

In a discrimination complaint filed with the Department of Health and Human Services' civil rights division last year, two patient advocacy groups alleged that four Florida insurers selling plans on ACA exchanges were requiring HIV patients to pay up to 50 percent of the cost of HIV medications, even for generic versions, which should in theory be cheaper. They also asked federal regulators to investigate whether this practice was happening more broadly across the country.

A new analysis published in the New England Journal of Medicine suggests that is the case. Of 48 exchange health plans Harvard School of Public Health researchers analyzed, they identified 12 plans that appeared to discriminate against HIV patients. In those plans, they found patients had to bear at least 30 percent of the cost for all NRTIs (short for nucleoside reverse-transcriptase inhibitors), one of the most commonly prescribed classes of HIV drugs.

Their conclusion: a person with HIV enrolled in these plans would on average pay at least $3,000 more each year to treat the condition than if they were enrolled in another plan.

"Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans," wrote the study authors, Douglas Jacobs and Benjamin Sommers. And that could be the case for patients with other complex conditions, not just HIV.

The NEJM study "is a confirmation of what we saw in Florida and why we filed the complaint, and why we've been pushing HHS to take some action on discrimination," said Carl Schmid, deputy executive director of the AIDS Institute, which was one of the patient groups that filed the federal complaint. "Some plans — not all — are discriminating against people with HIV by putting all their drugs in the highest tier. It's not just a Florida situation, it's around the country."...

See the full article in the Washington Post here.