Prescription Drug Coverage Unequal for People with Chronic Disease
A new study published in the New England Journal of Medicine found that insurance companies are discriminating against people with chronic diseases by making lifesaving drugs less affordable for people with certain conditions.
The study specifically analyzed H.I.V. drugs, and found that a quarter of insurance plans offered on the federal insurance marketplace put the drugs in the highest co-payment tier. Unlike many other drugs that can be bought with a flat-rate co-pay, H.I.V. drugs were put in a price tier that made the insured pay at least 30% of the total cost.
For a person taking drugs that cost nearly $28,000 per patient per year, the difference can be thousands of dollars annually.
Although the study specifically analyzed H.I.V. drugs, many consumer advocacy groups have noted the strategy of putting medicines into higher price brackets pertains to many chronic diseases. This practice, known as “adverse tiering,” has been used by insurance companies for other chronic illnesses, including diabetes and mental health disorders related to substance abuse.
Obama Administration Investigates Claims
These claims have caused the Obama administration to begin an investigation into the practice of adverse tiering. If found guilty of this practice, insurance companies will be breaking the anti-discrimination laws of the Affordable Care Act. In other words, they would be violating the measures put in place to protect people with pre-existing conditions.
People with chronic diseases tend to cost more money to insure for two reasons:
- They will be sick for a longer period of time
- They take more medication over the course of their lives
Consumer advocates believe adverse tiering is the insurance companies’ way of mitigating these costs.
Health Insurance Coverage for Addiction Rehab
In addition to concerns about prescription drugs, some rehab centers believe insurance companies have attempted to skirt other laws that make the substance abuse treatment affordable. In particular, insurance companies have been known to fight the Mental Health Parity and Addiction Equity Act. Enacted in 2008, this law means more affordable rehab for consumers because it prohibits insurance companies from making substance abuse treatment co-payments greater than other similar medical treatments.
Although the federal government has taken great strides toward making the treatment of chronic diseases, mental health problems, and substance abuse affordable, insurance companies are determined to protect their bottom line.
You can learn more about your health insurance coverage for addiction treatment here.