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New York Said to Investigate Insurers Over Hepatitis C Drugs
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After concerns were raised that there are some insurance companies that are restricting coverage of the medication of hepatitis C, the New York state attorney general has started an investigation and asked 16 health insurance companies to provide information on their coverage of hepatitis C treatments....amid concerns that some companies are restricting coverage of the expensive medications, according to a person familiar with the investigation.
Attorney General Eric Schneiderman's office has issued subpoenas to the health insurers asking for documents explaining how they decide who should be covered and who should not be covered for specific treatments. Owing to its price, the hepatitis C medications made by Gilead Sciences Inc. and AbbVie Inc. have garnered controversy.....http://mainenewsonline.com/content/16037329-ny-state-attorney-general-issues-subpoenas-16-health-insurance.....Medicaid, the US health program for the poor and disabled, has especially high rates of rejections for patients seeking hepatitis C drugs. Anthem, which operates the Empire Blue Cross Blue Shield insurance company, has said that it has expanded coverage of the hepatitis drugs.
Most of the insurance plans have been restricting the drug until patients' livers are being damaged, the attorney general's office found. Between 50% and 90% of patients whose doctors prescribed Harvoni were denied coverage by their insurer, the attorney general's office said.
"I do believe that because this is a disease predominantly of the marginalized—persons of color, drug users, the homeless, people who have been incarcerated—that there is an undercurrent of stigma that influences interests in spending money for this population," said Brianna Norton, hepatitis C medical director at Montefiore Health System's Comprehensive Health Care Center.
http://www.wsj.com/articles/insurers-probed-on-hepatitis-c-drug-coverage-1456965087
New York Said to Investigate Insurers Over Hepatitis C Drugs
http://www.bloomberg.com/news/articles/2016-03-03/new-york-said-to-investigate-insurers-over-hepatitis-c-drugs
Attorney General Eric Schneiderman's office has issued subpoenas to the health insurers, including Anthem Inc., Aetna Inc. andEmblemHealth Inc., requesting documents explaining how they make decisions on who to cover or not, said the person, who declined to be identified because the matter wasn't public.
The inquiry centers on whether the firms are engaging in misleading and deceptive practices, because the law requires accurate disclosure of what they cover and consider medically necessary, according to Mr. Schneiderman's office. Thousands of patients with hepatitis C may have been illegally denied coverage, according to the office.The New York Health Plan Association, which represents health insurers, said clinical guidelines for the hepatitis C drugs were quickly evolving and plans were adapting their coverage to the new medical information that becomes available.Empire BlueCross BlueShield, a subsidiary of Anthem Inc., said it relaxed its drug-approval criteria in December. "This decision was based on evolving medical evidence and unrelated to any regulatory inquiries," a spokeswoman said.
Anthem, which operates the Empire Blue Cross Blue Shield insurance company, said it recently expanded coverage of the hepatitis drugs.
"After several months of ongoing clinical review of the medical evidence and safety concerns surrounding hepatitis C treatments, coverage for Empire Blue Cross Blue Shield employer and individual health insurance plans was expanded for six of the newer oral treatments effective Dec. 7, 2015," Anthem spokeswoman Jill Becher said in an e-mailed statement.
Aetna and Emblem didn't respond immediately to e-mails seeking comment after regular business hours. The probe was first reported late Wednesday by the Wall Street Journal.
Leslie Moran, a spokeswoman for the New York Health Plan Association, an industry group, said in an e-mail that the scope of the subpoenas was too extensive.
Medicaid, the U.S. health program for the poor and disabled, has particularly high rates of rejections for patients seeking hepatitis C drugs. In a study of more than 2,000 patients between October 2014 and March 2015, disease management firm Trio Health found that Medicaid was denying prescriptions for at least 30 percent of patients. In comparison, at least 14 percent of patients were unable to start on treatment when covered by commercial insurers.
Trio Health found a huge variance from state to state. In Tennessee, 24 of 25 Medicaid patients weren't able to start on a Gilead or AbbVie regimen after getting a doctor's prescription, while in Connecticut, all 16 Medicaid patients surveyed were able to obtain treatment.
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