Life-Saving Drugs to Carry High Price Tag under ObamaCare Health Plans

Researchers with consulting firm Avalere Health found that 59 percent of silver-level plans on the new exchanges charge policyholders a percentage of the cost of specialty drugs rather than a fixed copay. Twenty-three percent of these plans have co-insurance rates of 30 percent or more of the cost of the drugs on the highest formulary tier, the analysis found. This rate increased to 60 percent among the lower-premium bronze plans, researchers said. The findings indicate that some patients will face higher or unexpected out-of-pocket costs on the exchanges when it comes to paying for specialty drugs. (The Hill)

Comments (11)

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  1. Suzy says:

    At what point will these higher Obamacare costs quit being termed “unexpected”?

  2. Barry Carol says:

    Specialty drugs that need to be infused or injected in a doctor’s office are usually covered as a medical benefit while drugs taken orally are covered under the prescription drug benefit. The co-pays may be quite different and it could be worthwhile for patients that have a choice to opt for the less convenient infusion / injection option if the out-of-pocket savings are significant and efficacy is comparable.

  3. Tom says:

    “However, these formulary designs often result in high costs for patients with chronic illness who need biologics and other products on the specialty tier.”

    And aren’t these the folks Obama said he was helping?

  4. Xanadu says:

    ….Patients can expect to pay higher than expected costs….Is there any aspect of Obamacare that does NOT fall under that heading?

  5. Steve says:

    “Twenty-three percent of these plans have co-insurance rates of 30 percent or more of the cost of the drugs on the highest formulary tier”

    Wow. That’s just bad.

  6. Lacey says:

    Health plans operating in the exchanges are using significant cost-sharing to meet actuarial values set forth in the law and limit premium costs

    Well that’s a bit icky, isn’t it? We’re having to charge people more for these medicines they need just to meet costs in the law?

    • Mary says:

      Well that’s what happens when you make a broken law. You get broken solutions.

    • Erik says:

      This has nothing to do with PPACA. It is the insurance companies turning a profit on pharmaceuticals. It was the insurance companies that set the formulary and the Co-pay, not PPACA. The insurance companies did not know what the adverse selection would be with new applicants so they hedged there prices to reflect that risk.