ICYMI: New Study Underscores Access Challenges in Essential Health Benefit Plans

Allyson Funk
Allyson Funk March 6, 2015

ICYMI: New Study Underscores Access Challenges in Essential Health Benefit Plans.

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In the latest analysis of barriers patients face to accessing needed medicines in exchange plans, a new study published in Health Affairs found “on average…exchange plans had…higher deductibles and cost sharing for prescription drugs” than employer-sponsored plans.

medical-billThe findings echo previous research on high cost-sharing for needed medicines in health insurance exchange plans due to burdensome copays, coinsurance and high deductibles that patients must meet before their medicines are covered– especially in the Bronze and Silver plans. These findings are particularly concerning  because burdensome out-of-pocket costs can impact medication adherence, which may result in adverse outcomes such as increased hospitalizations and higher overall health care costs for some patients. 

In light of the wide variation in coverage, the study authors conclude the function of the exchanges could be improved if there were “policies and programs to assist consumers in matching their prescription drug needs with a plan’s benefit design.” Consumers need easy-to-understand, readily available resources to help them compare costs and the coverage of medicines so they can choose the plan that works best for them and their family.

Topics: Access, Adherence, Affordable Care Act, Health Insurance, Out-of-Pocket Costs