Out-of-pocket costs for certain prescription drugs will rise considerably in 2015 for those who purchased coverage through the public exchanges last year as more exchange plans will be charging coinsurance payments of more than 30 percent compared to last year.
That's the finding of a study of exchange plans by Avalere Health, which examined data from the public exchange marketplace and from Covered California and New York State of Health.
Avalere looked at the costs that have been set for specialty medications used to treat life-threatening illnesses such as cancer, rheumatoid arthritis, or multiple sclerosis. It found the following increases in the percent of plans charging more than 30 percent for coinsurance compared to 2014:
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Platinum plans: 26 percent in 2015, 17 percent in 2014;
Gold plans: 22 percent in 2015, 20 percent in 2014;
Silver plans: 41 percent in 2015, 27 percent in 2014;
Bronze plans: 52 percent in 2015, 38 percent in 2014.
The cost increases for those in the silver plans will have the greatest effect on those who bought exchange coverage, since two-thirds of enrollees last year selected silver plans.
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"Overall, 80 percent of silver plans use coinsurance for consumer cost sharing on the specialty tier. In comparison, 91 percent of bronze, 80 percent of gold, and 66 percent of platinum plans charge coinsurance for specialty medications," Avalere said.
The increases raise the question of whether exchange patients will be able to afford these specialty drugs, said Dan Mendelson, CEO at Avalere Health.
"Competitive premiums are key to a sustainable exchange marketplace, which has led plans to pursue more significant cost-sharing," he said. "In some cases this could make it difficult for patients to afford and stay on medications."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
