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Health insurers focus so closely on the cost of care that they sometimes face charges that they discriminate against members with chronic costly conditions. Over the past year, patient advocates have complained to state and federal regulators that health insurers have failed to provide adequate insurance coverage to patients with cancer, HIV, mental health conditions and other illnesses (pdf).
For journalists covering insurance discrimination, the HIV cases offer important lessons about how insurers have used pharmacy benefit pricing strategies to shift the cost of medications to members. Health policy researchers and patient advocates contend that these pricing policies, including one called adverse tiering, are discriminatory.
This tip sheet explains issues and resources journalists will find valuable when covering pharmacy benefit discrimination cases.
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