Insurance commissioner denies Premera request for health plans and drug coverage
May 5, 2012 · Updated 10:17 PM
The following is a release from the office of Insurance Commissioner Mike Kreidler.
Insurance Commissioner Mike Kreidler has denied requests from Premera Blue Cross (Premera) to strip some of its health plans of vital prescription drug coverage.
Premera filed a request last week to remove all prescription drug coverage from its small employer plans. These are plans sold to employers with 1-50 employees. It also filed rates for adding several benefits to its individual plans but did not file the required contract language.
Its company Lifewise filed a request to remove prescription drugs from all of its catastrophic plans and wanted to require a health screen of any enrollee who wanted to switch to a more comprehensive plan with drug coverage. If a company replaces a product it must allow enrollees to select from any of its other plans, without requiring a health screen.
Kreidler has disapproved all of Premera’s and Lifewise’s requests.
“It’s deeply troubling that despite sitting on nearly a $1 billion surplus, Premera is still looking for ways to short change consumers,” said Insurance Commissioner Mike Kreidler. “Prescription drug coverage is an essential health benefit under the Affordable Care Act and will be required of all plans in 2014.”
Kreidler filed an emergency rule on February 15 letting health insurers know that generic-only prescription drug plans do not comply with state law and that any company with these plans must replace them by Aug. 1, 2012. Companies can continue to offer generic drug coverage, but they cannot deny people access to brand name drugs if they have a medical condition for which no generic drug exists or if a generic drug doesn’t work.
Diseases where no generic drug treatments may exist include certain cancers and mental illnesses, multiple sclerosis, rheumatoid arthritis and AIDS.
Only Premera and its company Lifewise sold generic-only health plans. Premera has 3,328 individual enrollees and 9,569 small group enrollees. LifeWise has 109,734 individual enrollees.
“This is a perfect example of how dysfunctional and broken the health care system is today without health reform,” said Kreidler. “At the same time that certain insurers are hoarding huge profits, they’re trying to cut benefits and avoid people who need health care. Insurance companies won’t be able to pull this kind of stunt in 2014. They’ll be forced to compete on price and quality, instead of finding new ways to avoid those of us unlucky enough to get sick.”