Perspective Pieces Address Coninsurance For Biologic Drugs, Genetic Nondiscrimination Law

Main Category: Health Insurance / Medical Insurance
Also Included In: Genetics;  Cancer / Oncology;  Public Health
Article Date: 25 Jul 2008 - 10:00 PDT

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Perspective pieces in this week's New England Journal of Medicine look at the health insurance coverage structure for biologic drugs and the Genetic Information Nondiscrimination Act. Summaries of the pieces appear below.

• "Tier 4 Drugs and the Fraying Social Compact": In an NEJM perspective, Thomas Lee, network president at Partners Healthcare System and an NEJM associate editor, and Ezekiel Emanuel, chair of the Department of Bioethics at NIH, examine the payment structure some insurers have implemented for expensive biologic treatments for cancer and other serious conditions. Under this structure, patients usually contribute coinsurance, a percentage of the cost of the treatment, rather than a copayment. Shifting a proportion of the treatments' cost to patients is a "politically feasible approach to holding down insurance premiums for everyone else -- even if it runs counter to the very concept of insurance," Lee and Emanuel write. However, the cost transfer is not a long-term solution to the issue of rising costs, they say, and they suggest a variety of other approaches to address the situation, including evaluating coverage for treatments based on effectiveness and necessity (Lee/Emanuel, NEJM, 7/24).
  
  
• "The Genetic Information Nondiscrimination Act -- A Half-Step Toward Risk Taking": In the article, Russell Korobkin, a professor at the University of California-Los Angeles School of Law and the UCLA Center for Society and Genetics, and Rahul Rajkumar, a medical resident at Brigham and Women's Hospital, discuss the Genetic Information Nondiscrimination Act, which was recently signed into law and prohibits health insurers from refusing to cover or raising premiums for individuals with genetic information or a family history that could put them at higher risk for certain diseases. According to the authors, the law, however, still allows insurers to refuse coverage for people with "immutable characteristics -- such as a finding on a colonoscopy -- that predispose them to illness." They write, "An insurance company can discriminate against these people in coverage and pricing because of the increased risk they represent, yet they bear no more responsibility for their increased risk than people whose genes predispose them to illness." The authors recommend prohibiting medical underwriting, the "rating and pricing of health insurance on the basis of any health information, not just genetic information" (Korobkin/Rajkumar, NEJM, 7/24).

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