Study: Insurers May Be Using Drug Costs to Discriminate

Thomas Northcut/Digital Vision/Thinkstock(NEW YORK) — A study in the New England Journal of Medicine claims that insurers may be using the costs of certain drugs to discriminate against “high-cost patients.”

Researchers analyzed “adverse tiering” in 12 states using the federal health insurance marketplace. Of those 12 states, six states included insurers cited in a complaint submitted to the Department of Health and Human Services in May 2014 (Delaware, Florida, Louisiana, Michigan, South Carolina and Utah), and the six most populous states with none of the mentioned insurers (Illinois, New Jersey, Ohio, Pennsylvania, Texas and Virginia).

Adverse tiering, the researchers explain, is an approach that aims to deter specific patients from enrolling in health insurance, for example, by ensuring that “enrollees with HIV will incur high costs regardless of which drugs they take.”

In each state, researchers looked at the plans with the lowest, second-lowest, median and highest premiums for the “silver” level health insurance, assessing the cost sharing for the most commonly prescribed class of HIV medications. In 12 of the 48 plans analyzed, the researchers say they found evidence of adverse tiering.

This problem, the researchers say, “will most likely lead to adverse selection over time, with sicker people clustering in plans that don’t use adverse tiering for their medical conditions.”

The researchers recommend mandating a percentage of drug costs paid by the plan to be set at a percentage threshold.

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