I Am Essential

Click on the image to see the ’I Am Essential’ letter.

The federal government must better define what constitutes discriminatory practices in health insurance policies, specifically as they pertain to people with chronic illness such as HIV, urges a letter signed by a coalition of 197 patient advocate groups called I Am Essential. The letter was sent to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services (HHS), reports Patient Daily News.

The coalition wants to ensure, for example, that health insurance plans would not be allowed to place all HIV meds in the highest cost tier.

The AIDS Institute is one of many HIV-related groups in the I Am Essential coalition. The letter highlights a proposed rule to Section 1557 of the Affordable Care Act (ACA, or Obamacame), which outlaws discrimination in the health care system based on race, color, national origin, sex, age or disability.

Carl Schmidt of the AIDS Institute told Patient Daily that the proposed rule fails to define discriminatory practices as they pertain to people “with serious and chronic conditions who rely on prescription medication and other health care services.”

The HHS has said it will not allow discrimination against people with HIV by placing all their meds in the most expensive plans. But Schmidt pointed out that the HHS hasn’t specifically named these practices in its proposed rules. “Any law or regulation is useless if it isn’t properly enforced and states can’t be expected to enforce it without guidance from the feds,” he said.

The I Am Essential letters suggest HHS take the following steps when finalizing the non-discrimination rule:

1. Define the following practices by health insurance plans as discrimination:

    • Placing all or nearly all medications to treat a certain condition on the highest cost-sharing tier

    • Not covering certain medications or not following treatment guidelines

    • Imposing excessive medication management tools such as unreasonable prior authorization and/or step therapy requirements

  • Charging high cost-sharing to patients with chronic conditions
  • Having narrow and exclusionary provider networks

2. Detail standards and parameters for benefit and plan design, including acceptable practices
 
3. Expand the definition of those protected under Sec. 1557 to cover all beneficiaries with chronic health conditions or serious illness