Analysis warns of higher drug costs in some O-Care plans

Analysis warns of higher drug costs in some O-Care plans
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Consumers who use specialty medications may face higher costs on ObamaCare's marketplace plans, many of which include co-insurance rather than copayments for the drugs, a new analysis warned.

Researchers with consulting firm Avalere Health found that 59 percent of silver-level plans on the new exchanges charge policyholders a percentage of the cost of specialty drugs rather than a fixed copay.


Twenty-three percent of these plans have co-insurance rates of 30 percent or more of the cost of the drugs on the highest formulary tier, the analysis found. This rate increased to 60 percent among the lower-premium bronze plans, researchers said.

The findings indicate that some patients will face higher or unexpected out-of-pocket costs on the exchanges when it comes to paying for specialty drugs.

In some cases, these charges will be counterbalanced with savings derived from other provisions of ObamaCare, such as the law's free preventive care and ban on lifetime and annual dollar limits on essential health benefits.

Still, Avalere officials warned that the plans' structure could be unpredictable for sick patients when it comes to paying for prescriptions.

"Health plans operating in the exchanges are using significant cost-sharing to meet actuarial values set forth in the law and limit premium costs," Avalere CEO Dan Mendelson said in a statement.

"However, these formulary designs often result in high costs for patients with chronic illness who need biologics and other products on the specialty tier. Tracing these patients to ensure that they are getting appropriate care is a critical quality need."