While the Affordable Care Act bans pre-existing condition exclusions, cherry picking and higher premiums for sicker individuals, a 2014 federal discrimination complaint and new study suggest that some public exchange plans have jacked up certain prescription drug prices.
Four Florida health insurers stand accused of requiring HIV patients to pay as much as half the cost of their medications, even for theoretically cheaper generic scripts, notes a report published in The Washington Post. Three of those carriers have since reached settlements with state regulators, while the fourth recently decided to cap monthly costs for patients at $200 for four drugs.
Two patient-advocacy groups leading the charge also asked the Department of Health and Human Services civil rights division to investigate whether this practice is occurring elsewhere across the U.S.
A New England Journal of Medicine analysis, in fact, found that 12 of 48 silver-plated HIX plans studied by Harvard School of Public Health researchers discriminated against HIV patients, who were charged at least 30% for a commonly prescribed drug class known as nucleoside reverse-transcriptase inhibitors. Their annual out-of-pocket cost was found to be at least $3,000 more on average in these plans compared with others.
Douglas Jacobs and Benjamin Sommers, who co-authored the study, wrote that many insurers may be using benefit design to dissuade sicker people from choosing their plans. However, Americas Health Insurance Plans spokeswoman Clare Krusing was quoted as saying the researchers failed to consider the wide range of consumer choice in HIX plans.
In addition, health insurers argue that the ACA caps annual out-of-pocket costs at $6,600 and $13,200, respectively, for individual and family coverage, while some HIX enrollees qualify for cost-sharing subsidies over and above financial assistance to pay their monthly premiums.
The Centers for Medicare & Medicaid Services indicated that HIX plans might be reviewed to determine whether insurers designed plans with high out-of-pocket costs for certain conditions, including bipolar disorder, diabetes, HIV, rheumatoid arthritis and schizophrenia, according to The Washington Post.
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