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Facing growing pressure, N.Y. insurers agree to lift restrictions on hepatitis c therapies

April 26, 2016
Last week, we wrote about the mounting evidence of insurer discrimination and coverage denials for patients with certain high-cost health conditions such as HIV and hepatitis C. In many cases, insurers have been denying new hepatitis C treatments to patients unless their livers showed signs of severe damage – despite guidelines from major medical societies recommending the drugs for nearly all hepatitis C patients.

Today, the Wall Street Journal reported some good news for hepatitis C patients in New York. Facing growing pressure from NY Attorney General Eric Schneiderman, seven insurance companies have reached an agreement with his office:
The agreements, expected to be announced Tuesday, require the insurers to cover hepatitis C medications for nearly all patients who have commercial insurance plans in the state.

Last year, Mr. Schneiderman’s office began an investigation into coverage of drugs for chronic hepatitis C, issuing subpoenas for documents and claims data to all commercial health insurers in the state. The investigation showed a wide discrepancy in how companies cover these drugs and found some insurers largely covered only patients with advanced stages of the disease, the attorney general’s office said.

Five of the insurers denied from 30% to 70% of claims, the office said.

Read the full story here. While the New York health plans’ belated change of heart amid increasing public scrutiny is welcome news, the problem of insurer discrimination and coverage denials remains widespread (see: Harvard Analysis of Discriminatory Formulary Design in 2016 Health Plans). Health plans nationwide should remove restrictions on medically appropriate therapies for the patients who rely on them and not wait for a subpoena to stop such blatant discrimination.