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‘Unconscious bias’ plagues Ingham Co. health insurance

Life-saving drugs excluded for HIV, gender transition

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Ingham County could soon revamp its health insurance offerings after officials found that multiple employees have had difficulty accessing name-brand HIV treatment and other medications to facilitate gender transitions.

And some county commissioners contended an “unconscious bias” against those with HIV and the LGBTQ+ community could be blamed for the access issues as they look to level the playing field on prescription drugs.

“These medications can be a matter of life and death,” said Commissioner Ryan Sebolt. “These are medications that are literally keeping some people alive. If you can’t access them, it shows our coverage is lacking. Employees should not be jumping through hoops to access their medication. This really is a top priority for the county.”

An unnamed county employee living with HIV confronted the commission’s County Services Committee last week with complaints over difficulty accessing a name-brand treatment plan prescribed by his doctor. Those medications, for reasons still under investigation, were found to be specifically excluded from coverage.

City Pulse is withholding the identity of the employee in consideration of the cultural stigmas attached to HIV.

“I fell victim to discriminatory prescription coverage and procedures that directly contradict the core values that Ingham County has laid out for me,” he told commissioners. “I would have to switch to a generic drug. Without that prescription coverage, I’m forced to use temporary assistance programs. … I’m here today to ask for help.”

Ingham County this year funneled its employee health insurance offerings into a self-funded pool that includes employees in the city of Lansing and the Community Mental Health Authority amid efforts to save cash. Officials said the switchover is saving about $2 million annually, but it also includes a new list of exclusions.

Among those excluded medications are standard fare for the health insurance industry: Botox; drugs to induce abortions; anabolic steroids; anti-wrinkle agents; sexual dysfunction medication; hair removal products; hair growth products. But it also specifically prohibits name-brand HIV drugs and treatment for gender dysphoria.

“The policy as it exists literally excludes every transgender employee. That is unacceptable. That is discrimination,” said Todd Heywood, board chairman at Ingham Community Health Center. “The only two chronic diseases or issues that require medication on the list of exclusions are for HIV and for gender identity. This whole system is deliberately designed to exclude people based on their otherness within the community.”

Commissioners are largely unclear how those specific medications managed to find their way onto the list of exclusions for county employees, but they’ve launched an investigation to eventually lift the restrictions. A forthcoming report from county Controller Tim Dolehanty is designed to provide some answers next month.

“It’s just not acceptable that our employees have to go through this type of stress or hassle in order to get life-saving drugs,” said Commission Chairman Bryan Crenshaw. “We need to get this right and very quickly. The biggest issue is making sure employees have access to the medication they need and deserve.”

Generic rather than name-brand HIV treatment medication, Heywood explained, is often behind the curve of constantly evolving research on the virus. Drugs that aren’t on the cutting edge of medical technology often include a host of negative side effects and can lend to a substandard method of treatment for county employees.

And because the FDA has yet to formally approve any method of hormonal transition treatment for transgender patients, all medication for gender dysphoria is currently prohibited on the county’s insurance plan as well. Ingham County, however, is not alone. Transgender-inclusive healthcare benefits are a nationwide scarcity. The Human Rights Campaign tracked fewer than 20 percent of its rated municipalities as offering those benefits.

“We’re in a fortunate situation where we might be able to make some of these determinations for ourselves,” Dolehanty added. “I don’t know why this is happening, but we’ll be sure to find out so we can address the problem. The focus is all about getting employees access to their medication as efficiently as possible.”

County employees, in theory, can still access excluded medications, but not without seeking an exception and repeatedly revealing their personal medical histories to the county’s human resources department, an insurance benefits facilitator and numerous other third-party assistance programs to piece the prescriptions together.

And while that process might work for some, some officials said it can pose undue obstacles to proper coverage.

“It makes my skin crawl that someone would have to repeatedly disclose their medical history like this,” said Commissioner Robin Naeyaert. “Patients shouldn’t have to disclose that to anyone but their physicians. The idea that any employee would have to divulge such personal information like this makes me physically ill.”

As an added consequence for Ingham County’s prescription access issue, the Ingham Community Health Center this year was demoted to a “top performer” rather than a “leader” in the Human Rights Campaign’s annual Healthcare Equality Index. Officials attributed the diminished status to the newfound coverage gaps.

“This creates a real question of hypocrisy in terms of county values and county procedures,” Heywood added. “We have a non-discrimination ordinance, but this system deliberately discriminates against some of our own employees. There’s absolutely an unconscious bias that plays into this. It’s our job to see this thing gets fixed.”

Visit lansingcitypulse.com for continued coverage as county officials continue to investigate the insurance shortfall.

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