High Cost of Medicines in Health Insurance Exchange Plans Is Harming Patients

Robert Zirkelbach
Robert Zirkelbach June 12, 2014

High Cost of Medicines in Health Insurance Exchange Plans Is Harming Patients.

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PhRMA President and CEO John J. Castellani recently joined several patient organizations to raise concerns about patients’ access to medicines in the new health insurance exchanges.  They discussed findings from a new report by Avalere, commissioned by PhRMA, which shows that many patients, particularly those with chronic disease, are facing exorbitant out-of-pocket costs to access the prescription medicines they need to manage their conditions.

The Avalere findings reveal that in seven of 19 classes of medicines for serious illnesses, such as cancer, HIV/AIDS, autoimmune diseases such as rheumatoid arthritis and multiple sclerosis, and bipolar disorder, more than 20 percent of Silver plans require coinsurance of 40 percent or more for all drugs in those classes. Similarly, in 10 of the 19 selected classes, at least 20 percent of Silver plans require coinsurance of 30 percent or greater for drugs in the classes.

The study also finds that more than 60 percent of Silver plans place all covered medications for multiple sclerosis, rheumatoid arthritis, Crohn’s disease and certain cancers in the plan’s highest formulary tier. For HIV/AIDS therapies, about 25 percent to 35 percent of plans place all covered medications on the highest tier.

This cost burden leaves many patients with nowhere to turn and can negatively affect patients’ health, and even their lives, by limiting access to needed care.  Moreover, when patients can’t adhere to their treatments the overall health care system faces greater strain. As Virginia Ladd, President and Executive Director of the American Autoimmune Related Diseases Association noted, “It’s a matter of paying now or paying later.”

To gain a deeper perspective on how treatment of prescription medicines in exchange coverage is impacting patients, we asked the following question in our Conversations forum:

How are patients with chronic conditions who have exchange coverage affected by high out-of-pocket costs for medicines?

I encourage all of you to join the conversation both online and on social networks Facebook and Twitter and share your thoughts about this important issue.

Topics: Patients, Health Insurance, Access Better Coverage