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Advocates Claim Civil Rights Violations of Chronically Ill From Benefit Design

Patient advocate groups yesterday appealed to the state’s insurance commissioner to correct “a potentially illegal and discriminatory issue” affecting chronically ill patients in California.

In a letter from 23 patient groups to Insurance Commissioner Dave Jones, consumer advocates said the practice of asking the chronically ill to pay a larger share of expensive drugs violates the Unruh Civil Rights Act.

“Higher [out-of-pocket costs] or specialty tiers are discriminatory because they apply a totally different benefit structure to certain medicines that patients with particular diseases need,” the letter said. “By selectively applying high cost-sharing requirements to these drugs, while requiring lower, fixed co-payment requirements for other drugs, plans who use specialty tiers force certain patients who suffer from certain diseases to pay much more.”

Nancy Kincaid, press secretary for Jones, said “We will look into the issue and determine if regulatory intervention is necessary or appropriate.”

Liz Helms, president and CEO of the California Chronic Care Coalition, one of the groups to sign the letter, said:

“We’ve been hearing from our members that they’ve been having difficulty accessing medicines that have coinsurance rather than copays. So we’re asking the Department of Insurance to look at possible civil rights violations, specifically those that deal with people with chronic disease.”

The new hepatitis C drug, Sovaldi, has helped push the issue forward, Helms said, because the cost of treatment is high — as is the number of people who could benefit from its use.

“That’s a cure for a bigger segment of the population. And we’ve been waiting for cures,” she said. “But it needs to be affordable or people aren’t going to get their meds.”

Helms said there will be a gathering of health professionals to discuss the issue on May 29 in Sacramento.

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