“While it was reassuring to know the OCR did formally investigate our complaint, it was incredibly disheartening and deeply concerning to see them let the state’s largest insurer get away with such blatant discrimination,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute in an email.
“This was blatant discriminatory plan design, and the entities charged with enforcing ACA’s [the Affordable Care Act’s] patient protections let Blue Cross Blue Shield North Carolina off with not even a slap on the wrist. This is further proof that insurers are allowed to get away with as much as they can. And even when they are caught, there is no penalty. For insurance to work for people living with HIV and all patients, we need better federal and state regulation, oversight, and enforcement,” said Carl Schmid of the HIV+Hepatitis Policy Institute.
“While it is reassuring that OCR formally investigated our complaint, the harm to people living with HIV has been going on for years,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “This was blatant discriminatory plan design, and the entities charged with enforcing ACA’s patient protections let Blue Cross Blue Shield N.C. off with not even a slap on the wrist.”
To address formulary practices that lead to high costs for patients with chronic conditions, patient advocates are calling for formulary templates, thorough review of drug formularies prior to approval, more state and federal enforcement and oversight, penalties, congressional oversight, additional financial resources for the Office for Civil Rights (OCR) and more enforcement action against insurance companies. It comes as OCR said no penalties will be issued to Blue Cross and Blue Shield of North Carolina (BCBSNC), which placed HIV treatments on tiers associated with higher-cost sharing, in a practice advocates said was discriminatory. “What’s the purpose of these regulations and the laws (when) there’s no enforcement?” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, told Inside Health Policy.
An ongoing lawsuit over the use of copay accumulators is drawing to a close following the defendants’ and plaintiffs’ motions to dismiss their appeals. The ball is now in the federal government’s and state insurance commissioners’ courts to enforce a district court judge’s ruling, which states that manufacturer assistance must be counted toward patients’ out-of-pocket responsibility unless a brand-name drug has a medically appropriate generic equivalent.