Get the Facts

The Affordable Care Act was designed in part to prevent health insurers from discriminating against patients with chronic or pre-existing conditions. However, discrimination continues to occur.

Step Therapy (or “Fail First”) Requirements

Patients are forced to try and fail cheaper treatments before they are allowed to obtain the treatments prescribed by their doctors.

What it looks like: Your doctor prescribes a specific treatment to ease symptoms of a health condition, but your insurer refuses to cover the drug and instead requires you to try a different, cheaper option – and to fail on it – before you can obtain the treatment originally prescribed.

 




Premium Assistance Bans

Insurance companies target patients with chronic diseases by rejecting their premium payments if they rely on financial aid from nonprofit organizations.

What it looks like: You go for regular treatments to manage a disease such as hemophilia, cancer or kidney failure, and you qualify for help paying your insurance premiums. Then you receive a notice that your payment was rejected because your insurer no longer covers patients who rely on financial aid from nonprofit programs. You’re unsure how you can afford your health coverage and think you might be forced to switch plans or forgo the lifesaving treatment you need.




Drug Price Tiers

Insurers put different types of drugs in different tiers, with each tier requiring patients to pay more money.

What it looks like: You have a disease that requires a specific type of medication to treat, but your insurer decides to make all brands and forms of that medication cost more – meaning all available treatment options for your particular disease cost more for you than treatments needed by other patients. This is a form of discrimination.




Co-pay Assistance Bans

Insurers reject coverage to patients who rely on financial aid from hospitals, from nonprofits such as CancerCare or other organizations to cover their co-pays.

What it looks like: You need medication to manage diseases such as hemophilia or cancer, and you qualify for help paying for these drugs. Then you learn at the pharmacy that your insurance company is rejecting coverage because you rely on financial aid from nonprofit programs. You’re unsure how you’ll pay for your prescriptions and worry about the future of your health.




Limited Networks

Health insurance companies make it more difficult to obtain needed care by limiting providers serving patients with chronic diseases.

What it looks like: You have a disease that requires a specific treatment – such as a kidney patient who needs dialysis treatment several times each week to filter toxins from their blood. Your insurance company limits the network of dialysis providers it will cover, forcing you to find a new insurer or to travel farther or pay more for the treatment you need to survive.




Nonmedical Switching

Insurance companies limit prescription drug coverage to less expensive medications, requiring patients to use a different one than prescribed or forcing them off current, effective treatments.

What it looks like: Your doctor prescribes a drug to treat or delay progression of a disease, and it’s helping. Then, your insurance company forces you to switch to a different drug based on cheaper cost – even if it won’t necessarily help your condition and could cause a relapse of your disease.

 




Workplace

People with chronic conditions frequently must worry not only about their health but about their jobs, as employers’ policies may be murky or unfair when it comes to sick leave or other time off. They might be made to take unreasonable tests because of their disease, or face barriers to taking their needed medications.

What it looks like: An airplane pilot is required to jump through numerous hoops and take expensive, invasive testing because he has diabetes – even if he has successfully managed the disease. A woman with breast cancer is terminated while on leave for cancer-related health complications. These are just a couple of examples of the broad range of workplace discrimination cases faced by people with chronic diseases.

 




School

Students with chronic diseases may face discrimination in the types of activities they are allowed participate in, or how and whether they’re able to access their prescribed medical treatments.

What it looks like: A child with asthma is unable to easily access their inhaler while at school, or a student with diabetes is made to disrupt their day in order to access their insulin. A teen with epilepsy might be unfairly kept from participating in the same sports or other extracurricular activities as their peers. These are all instances of discrimination.