Health

Study: Insurers May Using Drug Costs to Discriminate

Published

10 years ago

January 29, 2015

Oakland Post

In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. Being uninsured in America will cost you more in 2015. In 2015, all taxpayers have to report to the Internal Revenue Service for the first time whether or not they had health insurance the previous year. Most will check a box. Its also when the IRS starts collecting fines from some uninsured people, and deciding if others qualify for exemptions. (AP Photo/Carolyn Kaster)

In this photo taken Aug. 21, 2014 shows health care tax forms 8965, in Washington. (AP Photo/Carolyn Kaster)

KELLI KENNEDY, Associated Press

FORT LAUDERDALE, Fla. (AP) — Insurance companies, perhaps more than previously thought, may be charging the sickest patients extra for drugs under the federal health law, in an effort to discourage them from choosing certain plans, according to a study released Wednesday.

One of the cornerstones of President Obama’s signature health law forbids insurance companies from turning away people with pre-existing conditions such as diabetes or cancer. Yet hundreds of patient advocacy groups say insurance companies have found a way to discriminate against these people, who are more expensive to cover because they require life-long treatments.

The companies do this by putting all of their medications in a special category where the patient is required to pay a percentage of the cost of the drug, rather than a flat co-pay. Some are as high as 50 percent, leaving people on the hook for thousands of dollars. That compares to the average $10 to $40 per-medication co-pay that most pay.

A study published in the New England Journal of Medicine only examined HIV drugs, but noted the problem applies to mental illness, cancer, rheumatoid arthritis, diabetes and other chronic conditions. Patient advocates have complained that prescriptions for these patients were virtually unaffordable in some plans offered on healthcare.gov.

The AIDS Institute even filed a formal complaint with Health and Human Services officials last summer about four plans in Florida. Georgia plans to file a similar complaint, but the scope of the problem has been difficult to gauge as many of the complaints have been anecdotal.

The researchers studied 48 plans in 12 states using the federal marketplace: Delaware, Florida, Louisiana, Michigan, South Carolina, Utah, Illinois, New Jersey, Ohio, Pennsylvania, Texas, and Virginia.

They found that one-quarter of the plans placed all of the HIV drugs into the highest-cost category and required consumers to pay at least 30 percent of the drug costs instead of a flat co-pay. Annual drug costs in these plans were more than triple compared with other plans ($4,892 to $1,615), according to the analysis. And 50 percent had to pay a separate deductible for drugs, compared to only 19 percent of consumers in other plans.

Insurers have historically placed drugs in categories with higher co-pays to encourage consumers to select generic or preferred brand-name drugs. The problem is exacerbated as more plans place all drugs, including generics, in the more expensive category.

“Our findings suggest that many insurers may be using benefit design to dissuade sicker people from choosing their plans,” the study noted.

Over time, researchers predicted sicker people will enroll in plans that don’t charge such high prices. That means certain plans could have a higher number of sicker, more expensive consumers than their competitors. The federal law has financial protections for those plans but some will be phased out in 2016.

The law does ban insurers from charging an individual more than $6,350 in out-of pocket costs a year and no more than $12,700 for a family policy.

Insurance companies say the main issue is increasing drug costs and they’re shouldering the bulk of it. But they acknowledge the increased prices are also passed onto consumers.

For example, Atripla, the most popular HIV AIDS treatment and one of the highest-selling drugs in the U.S., costs insurers $27,026 a year. Patients only pay a portion of that, said Clare Krusing, a spokeswoman for the trade association America’s Health Insurance Plans.

But insurers noted consumers have the flexibility to choose from plans at all levels with different cost-sharing requirements and that the health law has a component that rewards plans for value and efficiency “not on their ability to attract healthier enrollees,” Krusing said.

Advocates have asked federal health officials to intervene and nearly 300 patient groups sent a letter last month urging Health and Human Services Secretary Sylvia Burwell to beef up enforcement. The federal government has warned against such discrimination.

“We analyze plan information submitted by insurance companies to uncover discriminatory benefit designs, and work with outlier plans to update formularies so they do not discourage enrollment of consumers with specific medical conditions,” agency spokesman Aaron Albright said in an email.

It’s unclear what the penalties are for insurance companies who discriminate.

Meanwhile, insurance officials in some states are stepping in. Three out of four insurance companies restructured their plans in Florida late last year.

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California Black Media

Gov. Newsom Goes to Washington to Advocate for California Priorities

Gov. Gavin Newsom traveled to Washington, D.C., for meetings with senior Biden-Harris Administration officials and members of California’s congressional delegation. During the week, he pushed for increased resources to improve public safety and quality of life in California.

Published

1 week ago

November 26, 2024

Oakland Post

Gov. Newsom visits the White House on Nov. 14. Photo courtesy of Gov.Ca. Gov

By Bo Tefu, California Black Media

Gov. Gavin Newsom traveled to Washington, D.C., for meetings with senior Biden-Harris Administration officials and members of California’s congressional delegation.

During the week, he pushed for increased resources to improve public safety and quality of life in California.

“California is continuing our work to secure additional tools and resources to improve access to health care, clean air and water, and secure critical funding to support communities recovering from disasters,” said Newsom.

At the White House, Newsom met with President Joe Biden and key officials, advocating for disaster relief funding, healthcare expansion, and environmental protection. He also engaged in discussions with senior Biden-Harris officials, including Interior Secretary Deb Haaland, to address water quality improvements and the San Luis Dam project, which will support water supplies for two million Californians.

“Building on our strong partnership with the Biden-Harris Administration, California is working closely with the White House over the next two months to deliver the critical protections and resources our communities need,” Newsom said.

On Capitol Hill, Newsom met with California Senators Alex Padilla and Adam Schiff, along with other Congressional leaders, to emphasize the need to approve pending disaster funding, healthcare programs, and environmental protections. He also previewed California’s upcoming special session to proactively address potential federal challenges when President-elect Donald Trump is sworn into office.

Newsom’s discussions also focused on securing Medicaid waivers from the Center for Medicare & Medicaid Services (CMS) to enhance behavioral health services and reduce homelessness. The state seeks approval for the BH-CONNECT waiver, which would address behavioral health and homelessness, and the MCO Tax Waiver, which would provide over $20 billion for Medi-Cal to improve healthcare access.

Additionally, California is pushing for Clean Air Act waivers from the U.S. Environmental Protection Agency (EPA), which are crucial for enforcing air quality regulations. These measures are projected to prevent 11,000 premature deaths and provide $116 billion in health benefits over the next three decades, according to the Governor’s office.

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California Black Media

California Reports First Case of Mpox in the United States

On Nov. 16, the California Department of Public Health (CDPH), reported the first known case of clade 1 Mpox, previously known as Monkeypox, in the United States. However, the risk to the public remains low, according to the CDPH.

Published

1 week ago

November 26, 2024

Oakland Post

iStock

By Bo Tefu, California Black Media

On Nov. 16, the California Department of Public Health (CDPH), reported the first known case of clade 1 Mpox, previously known as Monkeypox, in the United States.

However, the risk to the public remains low, according to the CDPH.

“This case was confirmed in an individual who recently traveled from Africa and is related to the ongoing outbreak of clade I mpox in Central and Eastern Africa,” reads a statement the CDPH released.

According to the DDPH, “The affected individual received health care in San Mateo County based on their travel history and symptoms. The individual is isolating at home and recovering.”

Public health workers are also conducting a contact tracing exercise and reaching out to people who have been in close proximity to the affected person.

“The mpox specimens from the traveler are being sent to the CDC for further laboratory testing,” the CDPH press release continues.

Californians can take a number of steps to prevent Mpox. Here’s more information:

Preventing Mpox Infection

It appears clade I mpox spreads in a similar manner as clade II mpox, through close (skin-skin), intimate and sexual contact. The identification of a potentially more severe mpox version in the United States is a good reminder for individuals who have certain risk factors to take preventive action, including:

Getting vaccinated if you may be at risk for mpox. For the greatest protection, make sure you get both doses of the vaccine. Find mpox vaccine (JYNNEOS) near you.
Taking precautions if you were exposed to mpox. Get the mpox vaccine before symptoms develop and consider avoiding intimate contact with others for 21 days. Watch yourself for symptoms and get tested if they develop.
Preventing spread if you have been told you have mpox. Avoid contact with others until the rash is healed, clean and disinfect shared areas in the home, and notify people who may have been exposed.
Talking to your sexual partner(s).
Avoiding skin-to-skin contact with those who have a rash or sores that look like mpox.
Not sharing items with someone who has mpox.
Washing your hands often.
Protecting yourself when caring for someone with mpox by using masks, gowns and gloves.

Visit the CDPH website to learn more about Mpox with Sexual Health Toolkits and a Campaign Materials Page.

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California Black Media

California Department of Aging Offers Free Resources for Family Caregivers in November

In honor of National Family Caregivers Month this November, the California Department of Aging (CDA) is spotlighting a range of free resources to support caregivers of older adults and individuals with disabilities. Through its extensive network of Caregiver Resource Centers (CRCs) and Area Agencies on Aging (AAAs), the state provides essential tools to help caregivers manage their responsibilities while prioritizing their own health and well-being.

Published

1 week ago

November 26, 2024

Oakland Post

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By Bo Tefu, California Black Media

“Caregiving is a great act of love, and this month — and every day — we uplift California’s caregivers as the under-recognized backbone of our families and communities,” said Susan DeMarois, director of the CDA. DeMarois emphasized the need for caregivers to access available support to better balance their roles without compromising their own health.

California is home to more than 4.5 million unpaid family caregivers, who contribute an estimated $81 billion annually in economic value through their care. Most caregivers are women who balance work, family, and caregiving responsibilities, often at the cost of their physical and emotional health. Given California’s aging population, the demand for caregiver support is rapidly growing, underscoring the importance of these free resources.

Thousands of caregivers accessed these services in the 2022-2023 fiscal year, benefiting from tools like professional care management and respite support. The Aging in California Resource Guide, available in six languages, offers additional information on caregiver support.

Caregivers can learn more about available resources by visiting the CDA website at aging.ca.gov and connecting with local CRCs or AAAs to discover personalized services to support them in their caregiving journey.