Analysis: Costs rising for specialty drugs on exchanges

Out-of-pocket costs appear to be rising for people on ObamaCare's exchanges who take specialty medications for rare or severe illnesses.

A new analysis by consulting firm Avalere Health found that the most popular health plans on the marketplaces are beginning to adopt targeted cost-sharing measures for drugs at a higher rate.


The practice of co-insurance — when patients are charged a percentage of a drug's cost as opposed to a blanket copayment — is specifically taking off.

The share of silver plans on the marketplaces that charge co-insurance greater than 30 percent for specialty medications rose from 27 percent in 2014 to 41 percent in 2015, Avalere found.

Two-thirds of marketplaces enrollees chose silver plans last year, the analysis noted.

The trend underscores the notion that while premiums on the exchanges rose slowly for 2015, consumers will pay a variety of out-of-pocket costs not reflected in their base monthly coverage bill.

Avalere Health CEO Dan Mendelson said insurers are adopting higher cost-sharing in order to keep premiums low and appealing to price-sensitive consumers. 

"Competitive premiums are key to a sustainable exchange marketplace, which has led plans to pursue more significant cost-sharing," Mendelson said in a written statement.

"In some cases this could make it difficult for patients to afford and stay on medications," he said.

The share of exchange plans that charge cost-sharing for specialty drugs varies based on the tier, Avalere found.

A full 91 percent of bronze plans — the cheapest option — require consumers to pay a percentage of specialty drugs, compared with 66 percent of platinum plans.