I Am Essential
Click on the image to download the letter sent to
the secretary of Health and Human Services.

The White House must do a better job of protecting patients from discrimination and unfair drug pricing under the Affordable Care Act, asserts a letter from the I Am Essential coalition of patient groups sent to Health and Human Services Secretary Sylvia Burwell.

“While we are encouraged by the administration’s repeated statements that plans cannot discriminate against patients, by, for example, placing every drug to treat a certain condition on the highest cost-sharing tier, we have seen little evidence of actual enforcement,” said Carl Schmid, deputy executive director of The AIDS Institute, in a press release from the I Am Essential coalition. “For these protections to be meaningful, CMS [the Centers for Medicare and Medicaid Services] and the states need to uphold the law and protect patients, particularly those who have serious and chronic health care needs.”

The letter to Burwell was signed by 124 patient group, including HIV/AIDS organizations.

The groups urge the Obama administration to better define what constitutes discrimination and then to enforce the rules.

CMS has indicated it will instruct issuers to not place all meds that treat a condition on the highest tier. According to the coalition’s press release, CMS also said it is looking into:

  • High plan cost-sharing and out-of-pocket costs

  • Drug formulary adequacy based on clinical treatment standards

  • Tier placement of drugs, including adverse tiering

  • Excessive prior authorization and/or step therapy requirements

You can read a PDF of the full letter by clicking on the image above.

And you can read further POZ coverage of this topic by reading:

Concerns: Cost Sharing of ARVs Under Obamacare

Proposed Obamacare Rule Fights Sex Discrimination. What About HIV?

These Obamacare Health Plans Limit Access to HIV Meds

Study: More Health Exchange Plans Put HIV Meds in Priciest Tier