Health insurers may be using drug coverage to discriminate

2 min read

Some insurers offering health plans through the new federal marketplace may be using drug coverage decisions to discourage people with HIV from selecting their plans, according to a new study from Harvard T.H. Chan School of Public Health. The researchers found that these insurers are placing all HIV drugs in the highest cost-sharing category in their formularies (lists of the plans’ covered drugs and costs), which ends up costing people with HIV several thousands more dollars per year than those enrolled in other plans.

The study appears online January 28, 2015 in the New England Journal of Medicine.

“Eliminating discrimination on the basis of preexisting conditions is one of the central features of the Affordable Care Act (ACA),” said Doug Jacobs, M.D./M.P.H. candidate at the Harvard T.H. Chan School of Public Health and lead author of the study. “However, the use of formularies to increase costs and dissuade those with preexisting conditions such as HIV from enrolling in the plan threatens to at least partially undermine this goal of the ACA.”

The researchers analyzed what they call “adverse tiering”—in which all drugs for certain conditions are placed in the highest cost-sharing tiers—in 12 states in the federal marketplace. They compared plans in six states that had been mentioned in a complaint to the U.S. Department of Health and Human Services (HHS) about adverse tiering, and in the six most populous states without insurers in the HHS complaint. They compared cost-sharing for a commonly prescribed class of HIV medication—nucleoside reverse-transcriptase inhibitors, or NRTIs.