Cost-sharing subsidies not helping with Rx costsNews added by Benefits Pro on June 5, 2014
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By Kathryn Mayer

Consumers who are eligible for cost-sharing subsidies under the Patient Protection and Affordable Care Act are still likely to pay high out-of-pocket costs on medications and other services.

That’s because of “inconsistent reductions in spending” depending on which plan a consumer chooses, according to analysis from Avalere Health. While almost all plans reduce deductibles and out-of-pocket caps in cost-reducing plans, researchers say, many don’t lower cost-sharing for other treatments and services, particularly specialty drugs.

See also: Drug fees surge under PPACA, report says

“Many people assume that the lowest-income exchange enrollees will have reduced cost-sharing across all services, but the reality is quite different,” said Caroline Pearson, vice president at Avalere Health. “While all plans must have reduced out-of-pocket limits for individuals earning less than 250 percent of poverty, how consumers will reach those limits differ significantly. For example, consumers may not experience reduced cost-sharing amounts for drugs or physician visits in many plans.”

Avalere looked at the silver and cost-sharing reduction plans offered in federally facilitated exchanges in 34 states, and found substantial differences in how carriers adjust cost-sharing benefits.

See also: Rx hurdles high under some PPACA plans

“While the Affordable Care Act requires CSR plans to lower maximum out-of-pocket limits, health insurers have broad flexibility about how to adjust cost-sharing for other services to reach the required actuarial values,” the report said. “Notably, plans do not evenly reduce cost-sharing across all types of benefits; in fact, plans vary substantially in how they alter cost-sharing for each of the benefits examined in this analysis.”

Researchers analyzed data from the Health and Human Services Department. Analysis was funded by the Pharmaceutical Research and Manufacturers of America, a trade group that’s criticized the Obama administration for failing to help consumers pay for high-priced prescription drugs.

Also read: Silver plan enrollees saddled with high out-of-pocket costs

Originally published on BenefitsPro.com
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