Consumers Will Pay More Out Of Pocket Next Year for Specialty Drugs

Americans with health coverage — including those who buy it through government insurance exchanges and Medicare beneficiaries — are likely to pay more out-of-pocket next year for so-called “specialty drugs,” which treat complex conditions, according to two studies from consulting firm Avalere Health. More than half of the “bronze” plans now being sold to individuals through federal and state marketplaces for coverage that begins in January, for example, require payments of 30 percent or more of the cost of such drugs, Avalere said in a report. That’s up from 38 percent of bronze plans this year. In “silver” level plans, the most commonly purchased exchange plans, 41 percent will require payments of 30 percent or more for specialty drugs, up from 27 percent in 2014. As the cost of prescription medications rise, insurers are responding by requiring patients to pay a percentage of specialty drug costs, rather than a flat dollar amount, which is often far less. Insurers say the move helps slow premium increases. But “in some cases this could make it difficult for patients to afford and stay on medications,” Avalere CEO Dan Mendelson said in a written statement.

Source/more: Kaiser Health News