Webinar Features States’ Fights against Discriminatory Cost-sharing

September 18, 2014

By Amanda Conschafter, blog editor

As concerns about insurers’ discriminatory practices against chronic disease patients grow, several states have taken steps to limit coverage models that require excessive cost-sharing. This week, the California Chronic Care Coalition hosted a webinar highlighting Montana and Delaware’s efforts to ensure patient access to vital medications. Both states have made important strides toward fairer out-of-pocket expenses for patients with high-cost diseases.

Montana’s experience began with complaints from its Multiple Sclerosis Society chapter that prescription drug plans sold through the state health care exchange in 2014 discriminated against MS and other chronic disease patients. Upon further inspection, the Office of the Commissioner of Securities and Insurance discovered that some insurance plans require post-deductible co-insurance of 50-90 percent. The office filed an objection, citing state laws against insurer discrimination and calling for “reasonably graduated” tiers, a representative of the commissioner explained.

The action resulted in insurers’ offering at least one Silver plan with pre-deductible co-payments. The issue also gave rise to calls for better consumer education. To improve health plan literacy, online plan summaries now include cost-sharing specifics.

Delaware efforts focused on private, employer-sponsored insurance plans. Concerned about discrimination against hemophilia patients, the National Hemophilia Foundation’s Eastern Pennsylvania Chapter joined with other patient advocacy groups to petition their state legislatures on the issue. State Senator Margaret Rose Henry introduced a bill calling for the Delaware Health Care Commission to conduct a study on co-payment and co-insurance practices.

The commission’s report recommended state regulation to address high cost-sharing. As a result, the Delaware legislature passed SB 137 in July 2013 requiring that insurers cap specialty drug co-payments and co-insurance payments at $150 per month.

As Ann Rogers from the National Hemophilia Foundation explained, approximately 30 states have already or are currently pursuing action on the issue of discriminatory cost-sharing policies against patients with high-cost and chronic diseases.

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