David Gately

Posts Tagged ‘health care’

8 Health Insurers in 7 States Allegedly Discriminate Against HIV Patients

In David Gately, Health, HIV on October 23, 2016 at 4:04 pm
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HIV medications

Cambridge, MA – A Harvard University healthcare advocacy group recently filed complaints against seven health insurers in eight states, claiming that they discriminate against HIV patients by making vital medications they need either too expensive or by not covering the drugs at all, according to Kaiser Health News.

The complaint was filed in September by the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI) with the Department of Health and Human Services’ Office of Civil Rights (OCR).

CHIPL argues that plans by Anthem Blue Cross Blue Shield, Cigna, Community Health Choice, Highmark, Humana, Independence Blue Cross, and UPMC Health Plan, in Alabama, Georgia, Illinois, Louisiana, Pennsylvania, Tennessee, Texas and Wisconsin, circumvent federal health care law, which profits insures from discriminating against people based on medical condition.

The result not only renders essential treatments unaffordable and unavailable for people living with HIV in those states, it’s alleged to violate both their health care rights guaranteed under the Affordable Health Care (ACA) and their civil rights protections under the Americans with Disabilities Act (ADA).

“What’s most important to us is that there’s a robust enforcement mechanism around the promises … in the ACA and its regulations, especially the anti-discrimination provisions,” said Kevin Costello, director of litigation at CHLPI.

The Harvard center, along with AIDS groups in seven states, examined silver-level–plans, where insurance companies pay 70%, and patients pay 30% and have lower out-of-pocket premiums–available on the Marketplace, to determine whether the plans cover six treatment regimens that are the current standards of care for treating HIV.

CHIPL says the insurers bypass the ACA and its regulations by refusing to cover single-tablet drug regimens that are often tied to better compliance because a number of effective medicines are combined in one pill.  Alternatively, the insurers place most or all of the drugs in the higher gold and premium cost tiers, with patients having to shell out higher monthly premiums, according to the complaint.

CHIPL found, for example, that Anthem silver plans in Wisconsin cover only four of the 16 drugs or combination products that are recommended to meet the current standard of care, and they fail to cover any single-tablet regimens.  In Illinois, the center charged that Humana’s silver plans place 16 of the 24 most commonly prescribed HIV drugs in the highest cost-sharing tier, which requires patients to pay 50 percent of the cost.

With estimated monthly costs ranging from $377 to $684 for different drug regimens, enrollees in the Illinois Humana plans would have to pony up between 8 and 14 percent of their average monthly income, according to the Harvard center.

Costello said although the complaints are addressing HIV drugs, the center hopes the complaint speaks to the larger issue of patients with chronic illnesses difficulty in accessing drugs.

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Ben Stiller says an early PSA test (and surgery) saved his life

In David Gately, Health, prostate cancer, prostate caner, PSA on October 11, 2016 at 9:04 am

ben-stiller

Actor Ben Stiller revealed last week that he is cancer-free after a controversial screening test diagnosed him with prostate cancer in June 2014. He credits his good health today on early detection and surgery to remove the tumor three months later.

Stiller, 50, made the announcement on Howard Stern’s Sirius XM radio and in an essay posted on the website Medium with the bold title “The Prostate Cancer Test That Saved My Life.”

“Taking the PSA test saved my life,” Stiller wrote in the essay.

The trouble is Stiller’s doctor tested his baseline prostate-specific antigen (PSA) levels when he was 46, and he choose to have surgery at 48, much too early according to many in the medical community.

The American Cancer Society recommends men begin PSA screening at age 50. And the U.S. Preventative Services Task Force (USPSTF), a group of independent medical experts that issue medical guidelines for doctors to follow, declared in 2012 that no man of any age should have the PSA test to screen for prostate cancer unless he has urologic symptoms.

PSA tests detect an enzyme that is released by prostate cells. Elevated levels of PSA could indicate cancer. In many cases, however, the cancers would progress so slowly that it would not threaten a man’s health or life.

Stiller said his doctor started monitoring his PSA levels after a year and a half of “rising PSA numbers.” He went for an MRI and biopsy and after learning he had a “mid-range aggressive cancer,” he elected to have his prostate removed.

But sometimes the surgery may not be worth taking.

“PSA tests find a whole lot of prostate cancers that will never kill people,” urological surgeon Dr. Peter Albertsen of the University of Connecticut Health Center told STAT  – a national publication focused on telling compelling stories about health, medicine, and scientific discovery – in 2015.

USPSTF’s 2012 recommendation was partly based on evidence that 90% of men with PSA-detected prostate tumors opt for treatment — biopsy, surgery and chemotherapy — but at least 20% of them will have adverse effects such as erectile dysfunction or incontinence.

Stiller wrote, “If he (his doctor) had followed the US Preventive Services Task Force guidelines, I would have never gotten tested at all, and not have known I had cancer until it was way too late to treat successfully.”

The good news is that prostate cancer diagnoses seem to have declined slightly. But a 2015 editorial in the Journal of the American Medical Association worried that fewer PSA tests would lead to more men dying from prostate cancer.

“I think men over the age of 40 should have the opportunity to discuss the test with their doctor and learn about it, so they can have the chance to be screened,” Stiller wrote. “After that an informed patient can make responsible choices as to how to proceed.