Health insurers offering Obamacare plans in several states are making it more difficult for HIV patients to afford their drugs even though the law forbids discrimination of those with pre-existing conditions, according to a study published in the New England Journal of Medicine.
Researchers studied the drug-benefit structures and cost-sharing definitions in 48 silver-level plans offered in 12 states that use the federal exchange, HealthCare.gov. A quarter of all plans engaged is what they called “adverse tiering.” That means insurers placed a common class of HIV medication in a tier that required at least 30% coinsurance or co-payment.
Authors wrote that the high cost-sharing for drugs indicated “that many insurers may be using benefit design to dissuade sicker people from choosing their plans.”
“That was surprising, how prevalent it was,” said Douglas Jacobs, a medical student at the University of California, San Francisco and co-author of the article.
The impetus for the study, Jacobs said, was a complaint filed last year with HHS' Office for Civil Rights. Consumer groups said four health insurers in Florida were illegally discriminating against HIV patients, Modern Healthcare reported. The plaintiffs argued the payers put all HIV drugs—including generic versions—in the highest cost-sharing bracket, which implicitly could dissuade the more costly, sicker patients from choosing that plan.
Insurers argued their exchange plans are compliant with the Patient Protection and Affordable Care Act, but critics contended it's a subtle way for insurance companies to continue coverage discrimination against sicker people.
However, Jacobs cautioned that the study should not be misconstrued to include all payers or all conditions. But he said it is worth monitoring.
“A majority of plans don't do this,” Jacobs said. “The concern would be if this were to become more widespread.”
Follow Bob Herman on Twitter: @MHbherman
