The New York Times (1/29, Thomas, Subscription Publication) reports that drugs to treat HIV and AIDS “are being priced out of reach for many patients enrolled in insurance plans through the new health care exchanges, despite warnings that such practices are illegal under the Obama administration’s health care law, according to a new analysis by Harvard researchers.” The study, published Wednesday in an article in The New England Journal of Medicine, examined 48 health plans in 12 states and found that a quarter of the plans “showed evidence of what researchers called ‘adverse tiering,’ or placing all of the drugs used to treat H.I.V. in a specialty tier where consumers are required to pay at least 30 percent of the cost of the drug.” Douglas B. Jacobs, the lead author of the study, said, “That’s really a large cost difference, and really is a very significant financial constraint for those with chronic conditions, particularly H.I.V.”
Bloomberg News (1/29) reports that Jacobs and Benjamin Sommers, both of the Harvard T.H. Chan School of Public Health, wrote, “Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans.” Bloomberg notes that in November, HHS issued proposed guidance for 2016 “that would make it harder for insurers to require high out-of-pocket costs for all drugs for a chronic condition.”
The AP (1/29, Kennedy) reports that nearly 300 patient groups sent a letter last month to HHS Secretary Burwell, urging the Federal government to ramp up enforcement. “We analyze plan information submitted by insurance companies to uncover discriminatory benefit designs, and work with outlier plans to update formularies so they do not discourage enrollment of consumers with specific medical conditions,” agency spokesman Aaron Albright said in an email.
The Washington Post (1/29, Millman) reports in its “Wonkblog” that Carl Schmid, deputy executive director of the AIDS Institute, said the NEJM study “is a confirmation of what we saw in Florida…and why we’ve been pushing HHS to take some action on discrimination.”
Jeffrey R. Ungvary President