Insurers discriminating against HIV/AIDS patients via drug costs – study

Reuters/Lucas Jackson
Through “adverse tiering,” some insurance companies may be offering prescription drug coverage via Obamacare in ways that discourage patients with major health problems from choosing their plans, according to a new study.

The Affordable Care Act, passed in 2010, barred insurance discrimination based on pre-existing conditions against anyone using the federal marketplace for coverage.

Yet a study released Wednesday in the New England Journal of Medicine found that some companies are "resorting to other tactics to dissuade high-cost patients," according to researchers at the Harvard T.H. Chan School of Public Health.

The researchers found that companies are listing medications in certain categories that require a patient to pay a percentage of the drug's cost, as opposed to a flat co-pay. Some payments are as high as 50 percent – which can lead to exorbitant costs – compared to the average $10 to $40 per medication co-pay that most customers pay, according to the Associated Press.

Using the healthcare.gov marketplace, the study’s authors, Douglas Jacobs and Ben Sommers, combed through 48 Obamacare policies from 12 states. They found that in 2014, 12 of the policies covered HIV drugs known as nucleoside reverse-transcriptase inhibitors, along with generic versions, in tiers with at least a 30 percent co-pay, oftentimes the highest amount. Some policies did not cover HIV/AIDS drugs at all.

"Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans," the researchers stated.

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The 12 plans offered an average annual cost per HIV drug of more than triple those for customers in other plans – $4,892 compared with $1,615.

"This matches what we've seen in Illinois, where four of seven plans have what we consider unaffordable HIV drugs," said John Peller, president of the AIDS Foundation of Chicago. "We think insurers are looking for ways to make plans less welcoming to people with chronic conditions."

The states involved in the study were Delaware, Florida, Louisiana, Michigan, South Carolina, Utah, Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia.

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The researchers noted that the issue doesn’t stop with HIV/AIDS drugs, but also applies to those that treat mental illness, cancer, rheumatoid arthritis, diabetes, and other chronic conditions, Reuters reported.

Insurers disputed that they are trying to weed out costly customers.

"Individuals can pick the policy that is best for them," said Clare Krusing, spokeswoman for America's Health Insurance Plans, an industry lobby, according Reuters. She added that subsidies are offered to customers to "reduce out-of-pocket costs for prescription drugs even more."

Patient advocates have called on federal officials to address enforcement of the Affordable Care Act’s non-discrimination tenets. About 300 patient groups sent a letter last month to US Health and Human Services Secretary Sylvia Burwell, calling for increased protections.

The agency said it has warned companies against discrimination.

"We analyze plan information submitted by insurance companies to uncover discriminatory benefit designs, and work with outlier plans to update formularies so they do not discourage enrollment of consumers with specific medical conditions," spokesman Aaron Albright told AP.