In the News

7 Insurers Alleged To Use Skimpy Drug Coverage To Discourage HIV Patients
Kaiser Health News
The health law prohibits insurers from discriminating against people with serious illnesses, but some marketplace plans sidestep that taboo by making the drugs that people with HIV need unavailable or unaffordable, complaints filed recently with the Department of Health and Human Services’ Office for Civil Rights allege. The effect may be to discourage people with HIV from buying a particular plan or getting the treatment they need, according to the complaint.

The complaints, brought by Harvard Law School’s Center for Health Law and Policy Innovation, charge that plans offered by seven insurers in eight states are discriminatory because they don’t cover drugs that are essential to the treatment of HIV or require high out-of-pocket spending by patients for covered drugs.

Drinks, junkets and jobs: How the insurance industry courts state commissioners
The Washington Post
Consumer advocates and some commissioners say the tight bond between regulators and the insurance industry — reinforced by campaign contributions, lavish dinners and the prospect of future employment — diminishes consumers’ voices as insurers press rate increases, shape regulations and scuttle investigations.

Harvard Law School’s Center for Health Law and Policy Innovation Files Federal Civil Rights Complaints Over Insurance Discrimination
Harvard Law School’s Center for Health Law and Policy
When an insurer requires chronically ill patients to pay a disproportionate share of the cost of medication it violates federal law” says Robert Greenwald, CHLPI’s Faculty Director and Clinical Professor of Law at Harvard Law School. “These are landmark Complaints that will benefit everyone looking to receive equitable, comprehensive health care through the Marketplaces by helping to define anti-discrimination law at a time when insurers are covering less and less.”

Rising drug prices the fault of insurers, not drug companies
Sacramento Bee
The insurance industry has managed to pull the wool over Americans’ eyes and convince them that drug prices aren’t tied to the pharmaceutical industry’s investments in research and development. That’s intuitively and factually wrong.

Health Insurers Pullback Threatens To Create Monopolies
Wall Street Journal
Nearly a third of the nation’s counties look likely to have just a single insurer offering health plans on the Affordable Care Act’s exchanges next year, according to a new analysis, an industry pullback that adds to the challenges facing the law.

Aetna to exit nearly 7 in 10 Obamacare plans
USA Today
Health insurer Aetna plans to cease its participation in the Obamacare health exchanges in all but four states.

The company's decision, which it blamed on heavy losses tied to the insurance plans, follows similar moves by competitors such as UnitedHealth Group

High Drug Prices Get Headlines, but Insurers Drive up Costs
San Francisco Chronicle
A promising new drug to treat hepatitis C, a liver disease afflicting as many as 150 million people worldwide, was recently introduced by Gilead Sciences Inc., a Foster City biopharmaceutical company...

Exclusive: Analysis Suggests Anthem Deal Could Raise Health Costs
As questions mount over whether health insurer Anthem Inc's proposed $48 billion purchase of Cigna Corpwill win U.S. antitrust approval, an exclusive analysis produced for Reuters suggests the merger could lead to higher costs for large companies offering workplace medical benefits...

Report: New Evidence Of Rising 'Obamacare' Premiums
Premiums for popular low-cost medical plans under the federal health care law are expected to go up an average of 11 percent next year, said a study that reinforced reports of sharp increases around the country in election season.

Proposed Premium Hikes Rattle Consumers Paying Their Own Way
Associated Pres
Millions of people who pay the full cost of their health insurance will face the sting of rising premiums next year, with no financial help from government subsidies.

Arizona Among States Facing Hikes in Obamacare Premiums and Deductibles
Arizona Business Daily
Arizona enrollees under the Affordable Care Act, also known as Obamacare, will see a significant increase in their health care premiums and deductibles when the marketplace opens ups for 2017 health care plans just one week before voters elect a new president.

Recent data released shows that premium rates and deductibles for the Affordable Care Act (ACA) Silver Plan on the Florida exchange are expected to rise by a staggering $866 dollars due to the expiration of the ACA reinsurance and risk corridor programs at the end of the year. Without the subsidy programs, insurance premiums alone will have to cover medical expenses for the first time in 2017...

BlueCross Plans Major Rate Increase as Obamcare Proves Costly
Chattanooga Times Free Press
Obamacare has helped extend health insurance coverage to more than 250,000 Tennesseans, but covering those enrolled in the new marketplace plans is proving costly for Tennessee's biggest health insurer.

In the first two years of offering the new plans under the Affordable Care Act, BlueCross BlueShield of Tennessee lost $311 million on such plans. The insurer says it is continuing to lose money again this year from Obamacare even after raising average premiums in the program by more than 60 percent over the past two years.

Despite the ongoing losses, BlueCross officials say they remain committed to participating in the marketplace exchange plans offered for individuals without access to other health insurance under Obamacare. But to cut future losses, the Chattanooga-based insurer may ask state regulators for additional rate increases next year even higher than the 36.3 percent implemented in January on its marketplace plans...

PBMs: The 'Shadow' Players in the Drug Pricing Skirmish?
With the U.S. drug pricing system as transparent as the darkest shadows, pharmacy benefit managers (PBMs) have stayed out of the political spotlight on the escalating cost of many drugs.

Over the years, they've touted their ability to lower prices by negotiating better deals with drug companies. With a few PBMs controlling nearly 80 percent of the market, their role in setting formularies, negotiating with drug sponsors and administering health plans, including Medicare Part D and employer plans, gives them a lot of weight at the negotiating table...

Don’t Deny Hepatitis C Patients a Cure
The Boston Globe
HOW DO you justify withholding a wonder drug from patients infected with a liver-killing virus until the disease starts to ravage their bodies? Why, in other words, do they have to become seriously ill before receiving help? Although biomedical advances have given rise to a new class of drugs that can cure hepatitis C, which is often fatal, a basic socioeconomic problem remains to be solved: Because of the high cost of the medicine, many public and private health insurers restrict access to treatment until the onset of liver damage. It’s a short-sighted approach that causes suffering and is at odds with a basic tenet of modern medicine — early intervention...