Earlier this year, BIO launched our Value Campaign. One of the main goals of this effort is to shine a spotlight on the insurance industry’s efforts to restrict patients’ access to the medications they need.
For years, the insurance industry and its allies have made patients pay more for less coverage. That’s just plain wrong.
In the post-Affordable Care Act (ACA) age, insurers—banned from excluding patients with pre-existing conditions—have taken to more creative means to discourage sick people from enrolling in their plans – such as outrageously high out-of-pocket costs or 50% coinsurance for the medications they need.
As a result of our efforts – people are starting to take notice.
States such as Florida, California, and New York have investigated, sued, or even fined insurers for blatant discrimination against the sickest patients, while hoarding billions of dollars of profits hidden away in huge cash reserves.
One group that has consistently sounded the alarm regarding the insurance industry and its discriminatory practices is Harvard University’s Center for Health Law and Policy Innovation (CHLPI). A 2015 study from the group on insurance coverage for HIV/AIDS patients found evidence of discrimination on numerous ACA exchange plans. This caused HIV/AIDS patients “covered” in these plans to pay an average of $3,000 more out-of-pocket for needed medications compared to other plans.
A later analysis found “there is increasing evidence that some [health plans] are structured to make specific medications, such as HIV and HCV medications, disproportionately expensive” and said “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.”
And now, once again, the group has taken action.
The center recently launched a new advocacy campaign to end insurance discrimination against those living with HIV or other chronic conditions. According to CHLPI, “these discriminatory practices include refusing to cover key medications and requiring high cost sharing for all medications used to address certain health conditions.”
In fact, the organization has joined with state partners and filed formal complaints against insurers with U.S. Department of Health and Human Services’ Office for Civil Rights to ensure this discrimination is stopped.
I applaud their work on behalf of patients everywhere. These people pay into their insurance—just like you and I do—with every paycheck, every week, of every year. And when they get sick, they expect their insurance to be there for them.
Let me be clear: BIO’s goal is not to tear down the insurance industry.
In fact, we want to work with them and all other stakeholders to find ways that we can improve the healthcare system for everyone. Every participant in the healthcare system must do their part to improve health outcomes and wellness for patients. But for too long, Big Insurance has sought any loophole they could to restrict access to the innovative breakthroughs and treatments discovered and developed by the biopharmaceutical industry. Their blocking of patients from needed medications cannot be tolerated.
We need more groups to stand with us and shine a light on Big Insurance, and more importantly, to participate in the dialogue to develop a 21st Century healthcare system as innovative as the care delivered through that system. We’re on the cusp of a new golden age of medicines. It’s very possible that the cures for many of the diseases that afflict those we love are right around the corner.
We owe it to ourselves and our loved ones have access to the treatments they need.