Supreme Court Takes Up Health Benefits Discrimination Case

A three-judge panel at the 9th U.S. Circuit Court of Appeals found in 2020 that the patients had stated a claim of disability discrimination under PPACA Section 1557 when they said their health plan had denied them "meaningful access" to prescription drug benefits.

The patients say in a pleading that siding with the patients would ensure that disabled people have equal access to health care.

The patients "simply seek equal access to the same pharmacy benefits currently available to other enrollees," the patients say.

Parents of children with disabilities argue in a brief that a Supreme Court ruling siding with CVS Pharmacy could have unintended effects on other types of discrimination claims, because it could shield defendants against claims based on allegations of non-intentional discrimination in other contexts.

Health Insurers' View

America's Health Insurance Plans says in a brief that siding with the patients would interfere with all types of provider-network-based health insurance, and raise the possibility that the courts could change health plan benefits in any way at any time.

If the 9th Circuit decision stands and affects other jurisdictions, "disparate impact challenges would seek to transform network-based plans into non-network-based plans; alter cost-sharing tiers for specialty pharmacy products; expand drug formularies; and curtail use of protocols that prioritize cost-effective treatments," AHIP says. "The result will be increased health care costs — one of the biggest problems facing our nation today — and deteriorating patient care."

The effects of a Supreme Court ruling letting the 9th Circuit decision stand would be felt immediately, AHIP predicts.

Surveys have shown that a majority of consumers would prefer cheaper health plans with narrower provider networks to more expensive plans with bigger provider networks, AHIP says.

CVS Pharmacy (Photographer: David Paul Morris/Bloomberg)