The rising out-of-pocket costs for specialty drugs withinAffordable Care Act plans is “most concerning,” according toHealthPocket’s report, "In The Fourth Year of Affordable Care Act Coverage,Specialty Drug Out-of-Pocket Costs Remain A Problem ForConsumers."

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Silver plans, the most commonly purchased ACA plan, saw averagecoinsurance rates increase by 16 percent in 2017. Enrollees thisyear pay an average of 36 percent coinsurance on drugs within thespecialty tier, compared to 31 percent in 2016. This increase inmonthly out-of-pocket costs for the top five specialty drugs rangedfrom $226.29 to $1,762.59.

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The average bronze plan specialty drug cost-sharing rose from 37percent of the retail price in 2016 to 39 percent in 2017, which isa 5 percent increase. For bronze plans, this increase in monthlyout-of-pocket costs for the top five specialty drugs ranged from$90.52 to $705.03.

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For gold plans, specialty drug cost-sharing increased an averageof 13 percent, with coinsurance expenses rising from 30 percent ofthe retail price to 34 percent. The 2017 increase in monthly out-of-pocket costs for the top 5specialty drugs ranged from $181.03 to $1,410.07.

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Platinum plans were the only plans whose specialty drugcost-sharing decreased between 2016 and 2017.

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“However, inasmuch as only 1 percent of marketplace consumersenrolled in platinum plans for 2017, platinum plans have minorsignificance to the market as a whole,” the study said.

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Cost-sharing obligations within platinum plans declined 11percent in 2017 compared to 2016. The decrease in monthlyout-of-pocket costs for the top five specialty drugs ranged from$181.03 to $1,410.07.

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“The increased cost-sharing exacerbates cash flow burdens forenrollees taking specialty drugs until they reach the annual cap onout-of-pocket costs,” the authors write. “However, these caps canbe quite high.”

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For enrollees within silver plans, the average cap on annualout-of-pocket costs is $6,449 in 2017 for an individual and $12,952for families. For entry-level bronze plans, the annual caps areeven higher: $6,904 for an individual in 2017 and $13,810 forfamilies.

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“Specialty drugs continue to attract attention from health careanalysts and politicians alike given their staggering costs toconsumers and insurers,” the authors write. “The unansweredquestion for ACA enrollees is whether 2018 will bring anyimprovements to ACA specialty drug cost-sharing.”

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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.