Keeping you updated on the latest Medicare and Part D news

Update: Discrimination Via Prescription Benefit Structures

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Update (1/23/2015):

All four of the four Florida insurers included in the complaint have reached agreements with state regulators to make HIV/AIDs medications more accessible, including lowering prices and removing prior authorization restrictions. Most recently, Preferred Medical Plan agreed to cap monthly out of pocket costs at $200 for four HIV/AIDs medications. The US Department of Health and Human Services is still investigating the insurers for potential discrimination.


Original post (7/11/2014):

The AIDS Institute and the National Health Law Program have filed a complaint against four Florida insurers for discrimination against beneficiaries with HIV/AIDS. The complaint included an analysis of Qualified Health Plan options in Florida, demonstrating how the four insurers were cost outliers that placed HIV/AIDS medications, both brand and generic, in the highest cost-sharing tiers.

Through high cost-sharing, quantity limits, and prior authorization requirements, prescription drug plans could discourage beneficiaries with certain medication needs from enrolling, notably those requiring expensive drugs. Discriminatory benefit designs are illegal on the health insurance exchanges, as well as Medicare Part D, and CMS has said that it will conduct outlier analysis to identify discriminatory benefit designs in Qualified Health Plans.

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