The rising out-of-pocket costs for specialty drugs within Affordable Care Act plans is “most concerning,” according to HealthPocket’s report, "In The Fourth Year of Affordable Care Act Coverage, Specialty Drug Out-of-Pocket Costs Remain A Problem For Consumers."
Silver plans, the most commonly purchased ACA plan, saw average coinsurance rates increase by 16 percent in 2017. Enrollees this year pay an average of 36 percent coinsurance on drugs within the specialty tier, compared to 31 percent in 2016. This increase in monthly out-of-pocket costs for the top five specialty drugs ranged from $226.29 to $1,762.59.
The average bronze plan specialty drug cost-sharing rose from 37 percent of the retail price in 2016 to 39 percent in 2017, which is a 5 percent increase. For bronze plans, this increase in monthly out-of-pocket costs for the top five specialty drugs ranged from $90.52 to $705.03.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
