by Amanda Conschafter, blog editor
Health insurers who deny patients access to hepatitis C cures could be violating federal law, explains an April 5 letter from the Alliance for Patient Access and The AIDS Institute to Florida’s insurance commissioner. The letter examines exorbitant cost-sharing requirements and prior authorization that rations care to only the sickest patients. Insurers intend these policy designs to dissuade hepatitis C patients from purchasing plans, the letter contends—and that is inconsistent with the Patient Protection and Affordable Care Act’s non-discrimination language.
Hepatitis C affects approximately 5 million Americans and can lead to severe liver damage, infections, liver cancer and death. For generations, treatment options were limited. A new generation of direct-acting antiviral medications offer a more than 90% cure rate, but many patients have struggled to access the cures due to health plan barriers.
For some, those barriers are slowly dissipating. In November 2015, the Centers for Medicare and Medicaid Services issued a notice to states reminding them of their legal obligation to provide necessary care to Medicaid patients, including those with hepatitis C. In March 2016, the Department of Veterans Affairs announced that increased federal funding allowed it to treat all patients, regardless of their stage of liver fibrosis.
But for many patients, including those in Florida, barriers remain. As the letter explains, some insurance companies in Florida provide no coverage for hepatitis C cures. Others require up to thousands of dollars in cost-sharing, pricing patients out of access. Insurers may also require prior authorization or limit the quantity of drugs available under patients’ plans.
These practices deny patients necessary treatment and deviate from standards of practice. Moreover, the letter charges, they contradict the Patient Protection and Affordable Care Act:
The actions of the insurance companies are designed both in financial terms and medical prior authorizations to discourage those with [hepatitis C] from joining insurance plans and therefore discriminate against those with a pre-existing medical condition. Such discrimination is contrary to the Patient Protection and Affordable Care Act…[which] prohibits federal health programs, activities and contracts of insurance sold through the health insurance Marketplaces from discriminating…against individual participants and beneficiaries based on health status.
For more on access barriers for patients with hepatitis C, read Improving Patient Access to Hepatitis C Cures.
