SACRAMENTO, Calif. (KTXL) – National Health Insurance Company has agreed to pay more than $1 million to the California Department of Insurance as part of a drug settlement, Insurance Commissioner Ricardo Lara announced Tuesday.
The department is being fined $1.995 million over prescription drug and patient information from an insurance company that officials say was unfair and discriminatory, according to a press release.
Insurance officials say the state’s insurance department said National Health violated California law by failing to post a list of prescription drugs online and charging higher prices for some drugs since 2015. The department said National Health denied consumers the information they needed. theater on Learning.
As of Dec. 31, 2021, National Health will no longer offer health coverage in the small and large employer group markets, according to state officials.
If the company decides to re-enter the health insurance market, there is an agreement with the government requiring National Health to maintain a program that complies with the company’s standards.
“This settlement is a win for consumers and a reminder to other insurance companies that we will continue to comply with California law, protect consumers, and ensure that companies conduct business fairly and transparently,” Lara said in a press release. “California’s law is clear. Insurance companies can’t make prescriptions that target consumers with serious medical conditions.
“Patients should have an accurate, up-to-date list of covered drugs and have the right to make medical decisions based on accurate information,” Lara said.
In its investigation of National Health, the insurance department said the company had several violations in its small and large employer group.
“When National Health posted its prescriptions online in 2019, it was not a prescription drug list, but an outdated list of prescription drugs,” the insurance department said in a release. “The department said the practice encouraged the enrollment of people with certain medical conditions. The mislabeling resulted in reduced benefits for consumers with certain medical conditions, which could deter policyholders from filing complaints or entice policy-seekers to seek coverage elsewhere.”
According to officials, the department says National Health has placed nearly all immunosuppressive drugs for rejection, all covered drugs for multiple sclerosis, HIV, hepatitis B, and hepatitis C in the high-cost category, regardless of name.
By putting both drugs at higher prices, the department said “people with chronic conditions may have been discouraged” from enrolling for treatment because of the cost.
Insurance officials said National Health requires prior authorization for all HIV drugs. According to the department, prior authorization allows the insurance provider to determine whether a drug is necessary before it is sold, instead of leaving the decision to the patient’s doctor.
“The need to obtain a prior authorization may cause delays and denial of medication to a consumer whose physician has determined that the prescribed medication is medically necessary,” insurance officials said.
Contraceptives, contraceptives, and other pharmacy products were placed in a category where they should be placed without cost in groups according to cost sharing for patients, officials said.
According to the Department of Insurance, health insurance companies cannot provide coverage that discriminates against people with chronic illnesses in California. Companies must provide services that “guarantee the availability of outpatient drugs,” the department said.
State health insurance policies also require copayments, coinsurance, and other cost-sharing for patients to be appropriate for patients so that they can receive treatment that is appropriate for outpatient treatment.