Dozens of patient advocacy groups that make up the I Am Essential Coalition praised the Department of Health and Human Services’ proposed standards for insurers during the 2018 coverage year.
HHS in August proposed a rule meant to strengthen the marketplace, proposing, among other things, a modification to calculating risk adjustment for enrollees who don’t remain with one insurer for an entire year and use prescription drug utilization data as a source of information about patients.
In a letter sent to HHS Secretary Sylvia Burwell on Thursday, 153 patient groups said they were encouraged by the department’s plans to extend standardized options plans into 2018, with the assumption that patients will be able to more easily compare plans across insurers. The groups encouraged HHS to go a step further and require issuers to offer the standardized plans in 2018.
They also praised HHS for proposing that plans continue using co-pays rather than co-insurance for most Simple Choice plans. “As beneficiaries cannot access drug price information prior to choosing a plan to calculate the dollar amount they will have to pay, such cost-sharing designs significantly disadvantage individuals who rely on prescription drugs to manage their chronic conditions during the plan selection process and can be characterized as discriminatory,” they wrote.
The groups also praised the decision to include prescription drug data in calculating risk adjustment, saying it will do more to further prevent discrimination against people with pre-existing conditions. Such an effective risk adjustment program can be helpful in stabilizing premiums, they said.
“In addition, we believe that compensating issuers through mechanisms like risk adjusters for their enrollees who need and use higher-cost prescriptions will encourage issuers to take responsibility for caring for these patients, remove incentives for avoiding the sickest patients, and reduce discriminatory practices that prevent vulnerable populations from accessing care and treatment,” they write.
HHS can go further to strengthen against discriminatory benefit design, they added, recommending that the department could require issuers to cover all medications recommended by current clinical guidelines or prohibiting insurers from placing all or most drugs in the highest cost tier.