Bethany Pray, Health News Colorado

“It seems everyone knows someone who’s had to pay hundreds or thousands of dollars a month for expensive prescription drugs – whether it’s to treat a deadly cancer like leukemia or an autoimmune disease like MS.

Before the passage of the Affordable Care Act, it was difficult for many people with such chronic conditions to buy health insurance at all. Now, thanks to the ACA, insurers must take all comers, whether or not they have pre-existing conditions.

Beyond that, the ACA states that plans offered on state or federal exchanges must provide essential health benefits, and that non-discriminatory plan benefit design is an integral part of that requirement. This means that the way plan benefits are structured – with particular copays or coinsurance, deductibles, provider networks or pre-authorization requirements – must not discriminate against people on the basis of “age, disability, or expected length of life.” (45 CFR §156.125.)

Unfortunately, the way that many health insurers structure payments for specialty drugs is still discriminatory. Because these drugs, also known as specialty drugs, are so expensive, insurers wrangle with how to cover costs without hurting the bottom line or raising premiums. As a result, they’ve increasingly favored a coinsurance model for these drugs since the implementation of the ACA. In Colorado, the trend has been steep, with nearly all carriers utilizing coinsurance on the highest tier, and coinsurance rates as high as 50 percent.

Responding to an outcry among consumers over this phenomenon, advocates from the Colorado Center on Law and Policy, Colorado Consumer Health Initiatives and the Chronic Care Collaborative began preliminary discussions with Colorado’s Division of Insurance (DOI) last spring.

Read the full article here

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