Wednesday, December 11, 2013

Fwd: qotd: Insurers using high drug cost sharing to scare away patients with expensive chronic disorders

Quote-of-the-day mailing list

-------- Original Message --------
Subject: qotd: Insurers using high drug cost sharing to scare away
patients with expensive chronic disorders
Date: Wed, 11 Dec 2013 11:22:17 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

The Washington Post
December 9, 2013
AIDS advocates say drug coverage in some marketplace plans is inadequate
By Ariana Eunjung Cha

The nation's new health-care law says insurers can't turn anyone away,
even people who are sick. But some companies, patient advocates say,
have found a way to discourage the chronically ill from enrolling in
their plans: offer drug coverage too skimpy for those with expensive

Some plans sold on the online insurance exchanges, for instance, don't
cover key medications for HIV, or they require patients to pay as much
as 50 percent of the cost per prescription in co-insurance — sometimes
more than $1,000 a month.

"The fear is that they are putting discriminatory plan designs into
place to try to deter certain people from enrolling by not covering the
medications they need, or putting policies in place that make them jump
through hoops to get care," said John Peller, vice president of policy
for the AIDS Foundation of Chicago.

As the details of the benefits offered by the new health-care plans
become clear, patients with cancer, multiple sclerosis, rheumatoid
arthritis and autoimmune diseases also are raising concerns, said Marc
Boutin, executive vice president of the National Health Council, a
coalition of advocacy groups for the chronically ill.

"The easiest way [for insurers] to identify a core group of people that
is going to cost you a lot of money is to look at the medicines they
need and the easiest way to make your plan less appealing is to put
limitations on these products," Boutin said.

Insurers say that such accusations are unfounded, and that the drug
coverage is more than adequate, with many plans exceeding the minimum
levels required by the Affordable Care Act. But they acknowledge that to
keep premiums low, they must restrict the use of some costly drugs if
there are alternatives. And they say that when high-priced medications
must be used, it's reasonable to expect patients to pick up more of the

But people who expected the new plans to provide pharmaceutical coverage
comparable with that of employer-sponsored plans have been disappointed.
In recent years, employers have compelled workers to pick up a growing
share of the costs, especially for brand-name drugs. But insurers
selling policies on the exchanges have pared their drug benefits
significantly more, according to health advocates, patients and industry

Robert Zirkelbach, a spokesman for American's Health Insurance Plans, an
industry group, said the exchange plans are designed "to try to give
consumers better value for their health-care dollars."

Comment: It is no surprise that private insurers would use every
devious trick to try to limit their payments for expensive drugs,
including requiring the patient to pay more through higher cost sharing,
or by omitting expensive drugs from their formulary altogether. From the
insurers' perspective, that's just good business. What is really
nefarious is that they are now using this to discourage patients with
expensive disorders from even enrolling in their plans.

Patients with HIV/AIDS, multiple sclerosis, rheumatoid arthritis, lupus,
cancer, hepatitis C, and other disorders who are on long term therapy
with expensive drugs will go elsewhere for their coverage when they find
that their current drug regimens would leave them with intolerable costs
under these plans.

A provision of the Affordable Care Act - guaranteed issue - requires
that insurers accept all applicants, no matter how expensive their care
is anticipated to be. But Obamacare did not change the nature of the
private insurance beast. Insurers will always find more ways to
circumvent requirements such as guaranteed issue.

Insurers boast to their shareholders about innovation in insurance
product design. The problem for us is that the innovations are not
designed to improve access and affordability for the insured. The
innovations are to improve the bottom line of the insurers.

Just think of the innovations we are already seeing - higher
deductibles, more limited provider choice through narrower networks,
limited benefits within each of the ten categories of required benefits,
and greater financial barriers to care such as these outrageous cost
sharing requirements for drugs.

The insurers are not through. When the insurance lobbyists are saying
that they are trying to "give consumers better value for their
health-care dollars," they really mean keeping insurance premiums low
enough to compete in the marketplace. They do that by paying as little
as possible for health care, shifting ever more of the costs to
patients. The sky is the limit on innovations when they are driven by greed.

We have the wrong people in charge - the insurers. We need our own
public financing system that is designed to help patients get care by
removing financial barriers. That's what an improved Medicare that
covered everyone would do for us.

Enough of this, "Boy, do we have a plan for you, and it's cheap, but if
you have anything wrong, study this plan carefully since you'll find
that it won't cover what you need (and then go away kid, you bother me)."

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