PhRMA, the Pharmaceutical Research and Manufacturers of America, recently posted a story on its blog Catalyst about CHLPI’s 2016 qualified plan assessments and findings. The blog post, titled “New research: Insurance plan structure can have discriminatory effect,” describes the forms of discrimination uncovered by CHLPI’s research, including high cost-sharing.
Excerpt from the blog post:
“New research from the Harvard University Center for Health Law and Policy Innovation (CHLPI) is another piece of evidence showing how health insurance plan design may be trying to discourage enrollment by patients with certain conditions and also preventing some individuals from actually getting care.
CHLPI looked at trends in state health insurance exchange plans over several years and reports they are “increasingly alarmed by lower rates of coverage for necessary HIV and HCV [hepatitis c] treatment regimens.” At the same time, cost sharing for those treatment regimens, even if the plan covers them, is increasing. They note, “This insurance practice has the discriminatory effect of discouraging individuals in needs [sic] of specific medications from enrolling in these plans or of shifting the burden of the cost back to these enrollees.” For example, the Harvard researchers found in 2016 some insurers are requiring coinsurance of 40 percent or more for all hepatitis c medicines; this high coinsurance is also sometimes required for most or all HIV medicines.”