Re:Obamacare Plans Bring Hefty Fees for Certain Drugs
by refurb on Monday March 24, 2014 @01:12PM
(#7459489)
This is actually a huge issue in the drug industry right now.
Most of the plans on the exchanges, but particularly the lower priced ones, have very large patient cost-sharing obligations. And it makes sense, if you pay a smaller premium each month, you'll have to pay a great share of the costs when the they do occur.
However, I don't think this will work out in the long run. It's one thing to ask a patient to pay 50% of a $300/month prescription (even though that's too much for many patients), but it's another to ask for 50% of a $10,000/month prescription (not uncommon for cancer).
The ACA did put a total cap on patient-cost sharing at $6,350 per individual or $12,700 per family [1]. This is a good thing since many plans prior had no limit on out of pocket costs. However, $6,350 is still a lot to ask lower income patients to pay.
One interesting outcome of this is that most drug companies are stepping up and offer patient assistance with these costs. For example, you might get a debit card that pays anything over $20, which makes it much more affordable. The funny part is that insurance companies typically hate patient co-pay cards since they defeat the purpose of co-payments (drugs the insurance company don't want you to use are more expensive). However, for the really expensive drugs, insurance companies are not complaining at all. In the end, it just results in a discount by the manufacturer, in a roundabout way.
Most of the plans on the exchanges, but particularly the lower priced ones, have very large patient cost-sharing obligations. And it makes sense, if you pay a smaller premium each month, you'll have to pay a great share of the costs when the they do occur.
However, I don't think this will work out in the long run. It's one thing to ask a patient to pay 50% of a $300/month prescription (even though that's too much for many patients), but it's another to ask for 50% of a $10,000/month prescription (not uncommon for cancer).
The ACA did put a total cap on patient-cost sharing at $6,350 per individual or $12,700 per family [1]. This is a good thing since many plans prior had no limit on out of pocket costs. However, $6,350 is still a lot to ask lower income patients to pay.
One interesting outcome of this is that most drug companies are stepping up and offer patient assistance with these costs. For example, you might get a debit card that pays anything over $20, which makes it much more affordable. The funny part is that insurance companies typically hate patient co-pay cards since they defeat the purpose of co-payments (drugs the insurance company don't want you to use are more expensive). However, for the really expensive drugs, insurance companies are not complaining at all. In the end, it just results in a discount by the manufacturer, in a roundabout way.
[1]https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...