Insurance Commissioner ends discriminatory practice
BILLINGS, Mont. – Montanans struggling to pay for the expensive drugs required to treat multiple sclerosis, cancer and other diseases could see dramatic savings next year thanks to a change in the way most Montana insurance companies cover prescription drugs.
Insurance Commissioner Monica Lindeen is requiring Montana’s four largest health insurance companies to cover all prescription drugs equally beginning next year, ending a practice she alleged was discriminatory because it treated certain drugs for a handful of common conditions differently than drugs used to treat other conditions.
“Montanans managing MS or fighting cancer have enough to worry about,”said Lindeen. “They shouldn’t be hit with higher prescription drug costs on top of it”
Lindeen will formally announce the change at a press conference here Friday, joined by representatives of the MS Society Chapter for Montana.
The conference will begin at 10 a.m. at the National MS Society Greater Northwest Chapter Montana offices in Billings at 2047 Broadwater, Suite 2. Members of the press and public are invited.
Traditionally, health insurance carriers have grouped the drugs they cover into tiers. There are a variety of ways companies offer prescription drug coverage, but drugs in each tier are covered in the same way.
Except for some drugs. Certain drugs used to treat MS, cancer, hepatitis and HIV, were put into a “specialty drug tier.” Drugs in that tier were covered differently, often requiring patients to spend many thousands of dollars upfront before receiving any drug benefit.
In 2015, for the first time, Montana’s four largest health insurance companies must sell policies that treat all prescription drugs the same. Importantly, plans sold in the silver metal tier and above will offer prescription drug coverage that includes flat dollar co-pays for all drugs, a benefit that will kick in immediately. Previously, some patients had to pay their entire deductible out-of-pocket, plus a percentage of the cost of the drug itself, before seeing a prescription drug benefit. Some patients would spend thousands of dollars at the beginning of year.
Lindeen urged Montanans to be careful insurance shoppers next year, because the change doesn’t mean that every insurance plan will include drug coverage affordable to everyone. Montanans will still have to read the details of any plan they intend to buy. But the end of the discriminatory practice means much more affordable drug coverage is much more available.