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Harvard Analysis of Discriminatory Formulary Design in 2016 Health Plans

March 30, 2016
BIO supports policy changes that protect patients’ ability to obtain access to the prescription drugs they need including policies that bolster enforcement of existing nondiscrimination requirement to ensure patients with high-cost health conditions are not penalized.

A recent assessment of 2016 Qualified Health Plans in the Exchange Marketplace in 14 states, conducted by Harvard’s Center for Health Law and Policy Innovation (CHLPI), raises significant concerns, noting “there is increasing evidence that some QHPs are structured to make specific medications, such as HIV and HCV medications, disproportionately expensive. This insurance practice has the discriminatory effect of discouraging individuals in need of specific medications from enrolling in these plans or of shifting the burden of the cost back to these enrollees.”

Details can be found here:

The report was also covered by the Star Tribune, which interviewed CHLPI attorney Carmel Shachar. Shachar noted that “When a plan offers all of its medication on 40 percent coinsurance, they know that they’re making themselves look very unattractive to people living with HIV.” View the full story here:

View the full story here: