Specialty Drugs Cost More Under Some Exchange Plans, Study Finds
U.S. residents who use specialty drugs could face higher costs for the treatments under health coverage purchased through the Affordable Care Act's exchanges, because certain plans feature coinsurance instead of copayments, according to an Avalere Health analysis released Thursday, The Hill's "Healthwatch" reports.
The analysis found that 59% of silver-level plans offered through the exchanges charged consumers a percentage of the cost of their specialty drugs instead of a fixed copay.
The analysis also found that:
- 23% of silver-level plans charged coinsurance rates that are at least 30% higher than the cost of the drugs; and
- Bronze-level plans -- with lower premiums -- charged coinsurance rates as much as 60% higher than the costs of treatments.
While these practices might raise expenses or become an unexpected out-of-pocket cost for consumers, the additional charges are expected to be counterbalanced by savings that result from other ACA provisions. However, Avalere officials noted that the way exchange plans are structured could pose a problem for sick patients' prescription drug costs (Viebeck, "Healthwatch," The Hill, 2/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.