Thursday, 29 January 2015

Have Insurers Found Way Around Obamacare 'Pre-Existing Conditions' Rule?


By Dennis Thompson

HealthDay Reporter

WEDNESDAY, Jan. 28, 2015 (HealthDay News) -- Some insurance companies may be using high-dollar pharmacy co-pays to flout the Affordable Care Act's (ACA) mandate against discrimination on the basis of pre-existing health problems, Harvard researchers claim.

These insurers may have structured their drug coverage to discourage people with HIV from enrolling in their plans through the health insurance marketplaces created by the ACA, sometimes called "Obamacare," the researchers contend in the Jan. 29 issue of the New England Journal of Medicine.

The companies are placing all HIV medicines, including generics, in the highest cost-sharing category of their drug coverage, a practice known as "adverse tiering," said lead author Doug Jacobs, a medical student at the Harvard School of Public Health.

"For someone with HIV, if they were in an adverse tiering plan, they would pay on average $3,000 more a year to be in that plan," Jacobs said.

One out of every four health plans placed commonly used HIV drugs at the highest level of co-insurance, requiring patients to pay 30 percent or more of the medicine's cost, according to the researchers' review of 12 states' insurance marketplaces.

"This is appalling. It's a clear case of discrimination," said Greg Millett, vice president and director of public policy for amfAR, The Foundation for AIDS Research. "We've heard anecdotal reports about this conduct before, but this study shows a clear pattern of discrimination."

However, the findings by definition show that three out of four plans are offering HIV coverage at more reasonable rates, said Clare Krusing, director of communications for America's Health Insurance Plans, an insurance industry group. Patients with HIV can choose to move to one of those plans.

"This report really misses that point, and I think that's the overarching component that is important to highlight," Krusing said. "Consumers do have that choice, and that choice is an important part of the marketplace."

The Harvard researchers undertook their study after hearing of a formal complaint submitted to federal regulators in May, which contended that Florida insurers had structured their drug coverage to discourage enrollment by HIV patients, according to background information in the paper.

source : Have Insurers Found Way Around Obamacare 'Pre-Existing Conditions' Rule?

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