Benefits designers may be intentionally luring insurance buyers into health insurance plans with high drug costs by keeping premiums artificially low.
A study of exchange marketplace health plans by Avalere Health found that most of the plans examined pushed all drugs used to treat complex diseases into the drug formulary with the highest cost-sharing tier. Avalere said the plan's premiums appeared to be kept low, with plan designers apparently expecting higher revenue from the drug cost-sharing to offset the low premiums.
"Plans continue to innovate on benefit design in the exchange markets," said Avalere CEO Dan Mendelson. "These designs are calibrated to optimize enrollment by delivering low and stable premiums — the primary metric that consumers use to select a plan."
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