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January 29, 2015 at 07:28 AM
(Bloomberg) — A quarter of plans under the Patient Protection and Affordable Care Act (PPACA) effectively discriminated against AIDS patients in 2014 by requiring high out-of-pocket payments for all HIV drugs in a key class, according to Harvard University researchers.
Their small study, published in the New England Journal of Medicine, examined AIDS drug costs in 48 plans under PPACA in 12 states, including Florida, Michigan, New Jersey and Pennsylvania. Twelve of the plans from seven different insurers required AIDS patients who used drugs in the key class to pay 30 percent or more of the cost for all of the drugs in the class. That practice may deter patients with HIV from enrolling in those plans, authors Douglas Jacobs and Benjamin Sommers, both of the Harvard T.H. Chan School of Public Health, wrote in the study.
See also: Many PPACA exchange plan enrollees use HIV drugs.
“Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans,” the researchers said.
Last May, in a federal civil rights complaint filed with the U.S. Department of Health and Human Services (HHS), the AIDS Institute and the National Health Law Program made similar arguments. The parties contended that four insurers in Florida were discriminating against AIDS patients in some of their plans by putting all HIV medicine in the highest drug payment tiers, which often require steep out-of-pocket payments based on a percentage of a drug’s cost.
Florida pattern
The new study shows that the pattern seen in AIDS drugs in Florida has been occurring in many other states, including New Jersey, Michigan, Utah, South Carolina, Pennsylvania and Louisiana, Jacobs and Sommers said in an interview. The Harvard study examined mid-level “silver plans” in 2014 and didn’t look into whether the limitations continued to occur in 2015.
See also: Exchange enrollees sicker than average.
“This reconfirms what we have been saying and seeing,” said Carl Schmid, deputy executive director of the AIDS Institute, which is based in Tampa, Fla. “There is obviously discrimination out there.”
Plan designs that left AIDS patients with no low out-of-pocket cost drug options were “fairly widespread,” said Jacobs, a public health student at Harvard and the study’s lead author. “It seems to be a very significant problem.”
Potential solutions
In November, HHS 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 rule would more clearly define that type of requirement as discrimination.
