Mul­ti­ple civil rights com­plaints pos­si­ble

GA Voice - - Front Page -

Al­ready set to charge higher health in­surance pre­mi­ums next year, most of the com­pa­nies that pro­vide plans via the Af­ford­able Care Act (ACA) mar­ket­place in Ge­or­gia are also try­ing to side­step one of the tenets of the ACA in the coverage they of­fer to peo­ple liv­ing with HIV/AIDS, ac­cord­ing to new data from the AIDS Re­search Con­sor­tium of At­lanta (ARCA).

ARCA an­a­lyzed all of the health in­surance sil­ver-tier plans avail­able through the ACA, which are the most com­monly used plans and are in­tended to be the mid­dle ground be­tween low-pre­mium, low-coverage bronze plans and more costly and com­pre­hen­sive gold and plat­inum op­tions. Re­searchers found that the four in­surance providers in Ge­or­gia — Blue Cross Blue Shield of Ge­or­gia, Al­liant, Am­bet­ter and Kaiser — placed most, if not all, of their HIV/AIDS med­i­ca­tions on a tier that re­quires the most out-of­pocket con­tri­bu­tion from con­sumers.

“A lot of in­sur­ers say that they’re not dis­crim­i­nat­ing be­cause they’re not chang­ing their pre­mium based on a pre-ex­ist­ing con­di­tion, which is what they would have done be­fore the Af­ford­able Care Act,” said Cal­lan Wells, who led the anal­y­sis of ACA sil­ver plans for ARCA.

“What we found is that one of the ways in which they are still caus­ing higher costs for peo­ple who do have HIV or AIDS is they’re charg­ing higher prices on the back-end,” Wells said. “The drugs that they are us­ing — the ones that are rec­om­mended — the in­sur­ers, specif­i­cally Blue Cross Blue Shield, have put those drugs typ­i­cally on the high­est tier of drugs.”

Pre­mium in­crease on the way

There is no stan­dard for struc­tur­ing coverage of med­i­ca­tions, with each in­surance Dr. Me­lanie Thomp­son, prin­ci­pal in­ves­ti­ga­tor at ARCA, and Cal­lan Wells, left to right. (Cour­tesy pho­tos) com­pany de­vel­op­ing its own tiers for drugs and how much coverage is in­cluded in each of those tiers. Most com­monly, drug com­pa­nies place generic drugs with a low co­pay on the bot­tom tier, and pre­ferred drugs that have a flat co-pay on the sec­ond tier; non-pre­ferred med­i­ca­tions with higher outof-pocket costs are on the third tier, while spe­cialty drugs that have a high, vari­able co-in­surance obli­ga­tion are placed on the high­est tier.

Blue Cross Blue Shield, Al­liant and Kaiser placed all of their HIV med­i­ca­tions on the high­est tier, re­quir­ing be­tween a 40-50 per­cent co-in­surance pay­ment by the con­sumer each month.

“What they do when they put all of their drugs on the very high­est tier is, in essence, dis­crim­i­nate against peo­ple with HIV by putting all of their drugs out of reach,” said Dr. Me­lanie Thomp­son, prin­ci­pal in­ves­ti­ga­tor at ARCA.

In Septem­ber, Ge­or­gia in­surance of­fi­cials ap­proved a pro­posal from all four in­surance providers to in­crease the cost of pre­mi­ums

Novem­ber 24, 2017

by more than 50 per­cent, mean­ing some 2018 plans re­quire con­sumers to pay up to $400 per month just to main­tain coverage.

“HIV drugs are of­ten hun­dreds of dol­lars for a 30-day sup­ply, and so even if that drug was $500, that’s still leav­ing a huge chunk that the con­sumer has to pay,” Wells said. “Ad­ding hun­dreds of dol­lars for the cost of the drug on top of in­creased pre­mi­ums, we be­lieve that it would be­come in­cred­i­bly un­af­ford­able, which is a way of still dis­crim­i­nat­ing.”

ARCA con­ducted the re­view of ACA plans in Ge­or­gia to help peo­ple nav­i­gate the fed­eral mar­ket­place, and has pro­vided its raw data to ACA nav­i­ga­tors at the Health Ini­tia­tive and at Ryan White clin­ics. But the anal­y­sis was also a col­lab­o­ra­tion with the Har­vard Law School’s Cen­ter for Health Law and Pol­icy In­no­va­tion, which is us­ing data from 16 states to try to im­prove ac­cess to med­i­ca­tions. The place­ment of HIV med­i­ca­tions in the high­est pric­ing tiers could sub­ject in- surance providers to mul­ti­ple civil rights com­plaints with the of­fice of civil rights at the U.S. De­part­ment of Health & Hu­man Ser­vices, which over­sees the ACA’s non-dis­crim­i­na­tion pro­vi­sion, Thomp­son said.

In 2016, ARCA and the Har­vard cen­ter filed a com­plaint re­gard­ing HIV med­i­ca­tion be­ing re­stricted to the high­est tiers against Hu­mana and Cigna, both of which no longer par­tic­i­pate in the Ge­or­gia ACA mar­ket­place. That com­plaint in­cluded com­par­ing whether drugs for other chronic con­di­tions such as rheuma­toid arthri­tis were placed ex­clu­sively in the most ex­pen­sive tiers.

“Some of the things that go into the de­ci­sion to file a civil rights com­plaint are not only how an in­surer treats an HIV drug, but how other in­sur­ers treat those same drugs,” Thomp­son said. “For ex­am­ple, one of the in­sur­ers puts all of the drugs on the high­est tier, an­other in­surer like Am­bet­ter has drugs on mul­ti­ple tiers, at lower costs.”

Blue Cross Blue Shield, which pulled out of the metro At­lanta mar­ket­place and is the only ACA provider in south Ge­or­gia and other ru­ral parts of the state, not only placed all of its HIV med­i­ca­tions on the high­est tier, but also does not in­clude com­mon HIV treat­ments in any of its coverage. Kaiser, one of the two providers cov­er­ing At­lanta, also put all of its HIV drugs in tier four and five, with most hav­ing a 50 per­cent co-in­surance pay­ment.

Am­bet­ter, the other provider of­fer­ing plans in metro At­lanta, stood out in ARCA’s anal­y­sis for the af­ford­abil­ity of its drug prices, although Thomp­son said it’s im­por­tant to re­mem­ber that the value of an in­surance pol­icy is not solely de­ter­mined by drug coverage.

“Am­bet­ter does spread out the HIV drugs onto a num­ber of dif­fer­ent tiers, and they have more drugs that have a flat co-pay,” Thomp­son said. “Some com­mon drugs are ac­tu­ally on a much more af­ford­able tier with a $50 flat co-pay, and their higher-tier spe­cialty drugs, which is pretty much the rest of the HIV med­i­ca­tions, ei­ther have a 20 per­cent co-in­surance, or no charge af­ter you meet the de­ductible.”

By RYAN LEE

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.