February 17, 2015
Study: More Health Exchange Plans Put HIV Meds in Priciest Tier
More health insurance exchanges place medicines—notably those for HIV, cancer and multiple sclerosis—in the highest cost-sharing tier, according to an analysis and related press release by Avalere Health. What’s more, a growing number of plans put all the drugs in a particular class on the highest tier.
The analysis included 20 classes of drugs. In five of them, the health plans put all the drugs in that class in the highest tier. Specifically, in the protease inhibitor class, 29 percent of plans put all the drugs—even the generics—on the highest tier.
The Avalere analysis looked at the silver plans in Florida, Illinois, Pennsylvania, Texas, Georgia, North Carolina, New York and California. The states represented about 60 percent of the total population enrolled in the exchanges in 2014.
In eight of the 10 classes, the plans were more likely in 2015 than in 2014 to put all single-source branded drugs in the highest tier.
In response to the analysis, Carl Schmidt of the AIDS Institute said: “What is new about this analysis is that the plans in 2015 are much worse than 2014. We believe some insurers are purposefully designing plans in such a way that discourages patients, particularly those with chronic health care conditions, from signing up for them.”
Schmidt continues: “This is clear discrimination and a violation of the Affordable Care Act (ACA). We need the ACA to work for all patients and for the federal government to enforce the strong non-discrimination provisions contained in the ACA. Without enforcement, how will patients afford their medications and who knows what the 2016 plans will look like?”
Read more stories here: http://www.poz.com/articles/avalere_analysis_insurance_1_26823.shtml
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