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Castellani: Health Law’s Cost-Sharing Could Limit Patient Access To Prescription Drugs

WebMD News from Kaiser Health News

By Mary Agnes Carey

Wed, May 07 2014

Enrollees in some of the health law’s most popular plans will face high cost-sharing requirements that the pharmaceutical industry says could keep patients from getting the drugs they need.

Most silver plans in the online marketplaces, or exchanges, require patients to pay for prescription drugs as part of the plan’s deductible, while nearly all bronze plans do, according to a report from Breakaway Health prepared for the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry’s trade group.

Silver plans that combine prescription and medical costs into one deductible — the out-of-pocket costs patients pay before coverage begins –  have average deductibles of $2,275, and similar bronze plans have an average of $4,986, according to the report. The average amount for plans that have separate prescription drug deductibles is $470 for a silver plan and $956 for a bronze one.

For a typical employer-sponsored health plan, on average people pay about 22 percent of the cost of prescription drugs and their insurance covers the rest, said John Castellani, who heads PhRMA. According to the analysis done for association, the health law’s bronze and silver plans require more than twice that amount. (Platinum and gold plans on the exchange generally have lower cost-sharing requirements but charge higher premiums.)

Of course, this isn’t the first time concerns have been raised about the affordability of coverage offered by the health law’s exchanges. Analysts and consumer groups, among others, have expressed fears that “sticker shock” on premium prices in some areas might discourage people from enrolling in coverage or, once enrolled, high cost sharing requirements for deductibles and co-pays could discourage people from accessing care when they need it.

But Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, offered a different take. He said in a statement that, before the health law, “plans did not have to cover drugs, and consumers could face unlimited out-of-pocket expenses for plans with limited benefits and high deductibles, if they could even get coverage without being denied for a pre-existing condition.” With the health law now in place, “prescription drugs are covered, out-of-pocket expenses are capped and there are no denials based on health, among other consumer protections.”

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