By Corinne Ramey
March 2, 2016
New York’s attorney general is investigating state health-insurance companies for allegedly restricting coverage of drugs that can cure hepatitis C, saying that the firms have inappropriately rationed care by denying patients expensive but effective medication.
Some of the drugs have been the subject of consumer lawsuits, a continuing inquiry by the Massachusetts attorney general and a warning by federal officials that state Medicaid programs may be violating federal law by denying patients the medication. Pharmaceutical companies say the drugs are worth the cost because they result in long-term savings in care.
New York state Attorney General Eric Schneiderman’s office has issued subpoenas to 16 health insurers—which includes all major commercial plans in the state—requesting documents on the companies’ processes for authorizing drugs used to treat hepatitis C and documentation on patients who have been denied coverage, said a person familiar with the investigation.
The subpoenas began to go out last fall, and some were sent as recently as two weeks ago.
The inquiry centers on whether the firms are engaging in misleading and deceptive practices, because the law requires accurate disclosure of what they cover and consider medically necessary, according to Mr. Schneiderman’s office. Thousands of patients with hepatitis C may have been illegally denied coverage, according to the office.
Representatives from Aetna Inc., CareConnect and EmblemHealth Inc. confirmed they received subpoenas but declined to comment.
The New York Health Plan Association, which represents health insurers, said clinical guidelines for the hepatitis C drugs were quickly evolving and plans were adapting their coverage to the new medical information that becomes available.
“We feel the subpoena is overly broad, and doesn’t take into consideration the impact of the excessive pricing of the drug,” an association spokeswoman said.