Americans taking high-cost medications are finding that mid- to lower-tier health plans offered through the new insurance exchanges often don’t cover their prescriptions adequately. Many could end up underinsured, making the 340B program even more critical to keeping them healthy.
Critics contend that insurance carriers are purposefully designing plans with weak pharmacy benefits for patients with expensive conditions like AIDS, cancer, and multiple sclerosis to discourage sign ups. Insurers say their products meet all federal requirements, but that’s cold comfort to patients who have no way to cover the high co-insurance rates that these plans set.
The Wall Street Journal reports on a letter sent by 31 HIV/AIDS organizations to Secretary of Health and Human Services Kathleen Sebelius noting “disturbing trends” and “egregious cost-sharing designs.”
For example, the group says that Aetna requires Florida patients to cover half of drug costs, after the deductible. Humana’s list of covered HIV drugs in Florida and Alabama lists just six HIV medicines and also includes a 50-percent copay.
“The easiest way [for insurers] to identify a core group of people that is going to cost you a lot of money is to look at the medicines they need and the easiest way to make your plan less appealing is to put limitations on these products,” Marc Boutin, executive vice president of the National Health Council, told The Washington Post.
Another problem: The law is so new, it’s unclear exactly what constitutes discrimination by an insurer.
“You are not supposed to design policies that discriminate, but what does it mean for a plan to be discriminatory? We don’t know that yet,” Kevin Lucia, a research professor at the Center on Health Insurance Reforms at Georgetown University told the WSJ.