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Insurers seek to shift more Rx costs to members

But lack of preferred generics means consumers don't have a cost-conscious choice, AJMC editorial notes

Payers have faced allegations that they discriminate against patients with certain health conditions; a violation under the Affordable Care Act.

But some insurers are finding ways around the non-discrimination provision by shifting more prescription costs to consumers.

Take the rise of costly prescription drugs, such as Solvaldi, used to treat hepatitis C. Many insurers now require that their patients front a larger portion of the cost of these pricy drugs, according to a recent editorial published in the American Journal of Managed Care.

What's more, since insurers classify drugs as "preferred" or "non-preferred", copays for generic drugs in the "non-preferred" tier are much higher than those in the first tier, notes the editorial.

To investigate possible discrimination, the editorial's authors examined coverage policies in plans with two tiers for generic drugs--both commercial plans and those under the Medicare Part D program.

They found that Metformin, which is a first-line treatment for type 2 diabetes, is a "non-preferred" drug in one plan. They also found that two plans do not offer a "preferred" generic anticonvulsant drug.

It could be argued that patients should be wiser consumers, note the authors. However, that can get tricky when most generic drugs are classified as "non-preferred" and thus have higher copays. The authors emphasize that if there are no "preferred" alternatives offered, consumers have no way to become more prudent consumers.

Harvard Pilgrim charges more for some generics because they are more expensive, the insurer said in an article co-published by ProPublica and the New York Times. The insurer also said its members pay less for their medications than the industry average.

Additionally, Blue Cross and Blue Shield of Illinois states that its "preferred" generic drugs have no copay, while "non-preferred" cost $10, notes the article.

For more:
- here's the editorial
- read the NYT piece

Related Articles:
High costs for specialty drugs hit patients, payers
Discrimination accusations plague insurers
Medicaid insurers struggle to pay for pricey drugs
AHIP slams pharma for taking advantage of insurers