ICYMI: Coverage of expensive drugs tops patients’ concerns

A new story from the AP today, “Patient advocates say insurers avoiding the sick,” highlights the growing concern among patients and insurance commissioners about high cost-sharing for medicines in the new health insurance exchanges. “Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers,” the article states.

The article highlights a letter 333 patient groups recently sent to HHS raising concerns about patients’ access to medicines. “We are increasingly aware of evidence that new enrollees, especially those with chronic health conditions, are still facing barriers to care,” they wrote. The letter highlights a number of ways patients’ access to medicines is being restricted, including “discriminatory benefit designs that limit access, such as restrictive formularies and inadequate provider networks; high cost-sharing; and a lack of plan transparency that may deprive consumers of information that is essential to making informed enrollment choices.” The letter notes that “some plans are placing extremely high co-insurance on lifesaving medications, and putting all or most medications in a given class, including generics, on the highest cost tier. This creates an undue burden on enrollees who rely on these medications.”

Additional highlights from the AP story:

1. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors.
2. More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions and may ... violate the (law's) nondiscrimination provisions."
3. The advocates also say they are disappointed by how difficult it's proved for consumers to get a full picture of plans sold on the new insurance exchanges. Digging is often required to learn crucial details such as drugs covered, exact copayments and which doctors and hospitals are in the network.
4. Washington state's insurance commissioner, Mike Kreidler, said "there is no question" that discrimination is creeping back. "The question is whether we are catching it or not," added Kreidler, a Democrat.
5. "They ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action," [Kansas’ insurance commissioner] Praeger said. "The whole goal here was to use the private insurance market to create a system that provides health insurance for all Americans."
6. California resident Charis Hill has ankylosing spondylitis, a painful, progressive form of spinal arthritis. To manage it, she relies on an expensive medication called Enbrel. When she tried to fill her prescription the pharmacy wanted $2,000, more than she could afford. "Insurance companies are basically singling out certain conditions by placing some medications on high-cost tiers," said Hill. That "is pretty blatant discrimination in my mind." Hill, a biking advocate from the Sacramento area, has been able to get her medication through the manufacturer's patient assistance program.