Enrollees in silver plans through the exchanges could be paying more than twice as much on prescription drugs than they would under a typical employer plan, new research finds.
The report — commissioned by the Pharmaceutical Research and Manufacturers of America and conducted by actuarial firm Milliman — found exchange participants are paying a “far larger increase in out-of-pocket costs than was found for other medical care.”
Overall, the report found that silver plan enrollees would likely pay 130 percent more for out-of-pocket prescription drugs compared to people on similar employer-sponsored plans.
The report looks at silver plans because they were the most popular.
“Americans participating in the exchanges were promised coverage comparable to employer plans and yet the reality is that many new plans are failing to provide an appropriate level of access to quality, affordable health care,” said John Castellani, president and CEO of PhRMA. “Patients face hurdles in accessing the medicines they need to manage their conditions, which is particularly problematic for Americans trying to control their chronic diseases.”
The report also noted that silver plans are nearly four times more likely to have a single combined deductible for medical and pharmacy benefits (46 percent of the time) compared to typical employer-sponsored plans (12 percent of the time).
“This is an important distinction, particularly for patients with chronic illnesses, as it means prescription medicines are not covered until patients meet the deductible,” the report noted. The typical deductible for silver plans is $2,000, according to analysis.
Researchers said higher out-of-pocket costs reduce patients’ likelihood of taking prescription medicines to manage chronic conditions, resulting in an increase in hospitalizations and higher health care costs overall.
