Platinum plans best for specialty drug consumers News added by Benefits Pro on August 27, 2014

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By Dan Cook

Though considered the most expensive of the Obamacare metal health coverage plans, platinum plans for certain consumers may be the most economical option.

When it comes to covering the cost of specialty drugs, platinum plans offer the lowest out-of-pocket cost to the consumer, according to a HealthPocket study of public information about the various metal plans from nine states.

HealthPocket looked at the average out-of-pocket costs for each exchange plan (platinum, gold, silver, bronze) on five common specialty drugs. These are defined as drugs that are expensive, treat complex conditions, and have few or no generic alternatives.

HealthPocket reported that “the average out-of-pocket platinum plan costs were 64 percent lower than gold plans, 74 percent lower than silver plans, and 78 percent lower than bronze plans.

“Even though platinum plans have the highest premiums among the four categories of Obamacare health plans, their reduced co-payments and lower caps on annual out-of-pocket costs can translate into lower overall costs for people taking specialty drugs,” HealthPocket said.

Characterizing the differences as “dramatic,” HealthPocket offered an example of out-of-pocket costs for the drug Humira, which treats inflammation. Going platinum “could result in annual out-of-pocket costs of $6,381.38 for 2015 bronze plans while costing only $1,416.67 for 2015 platinum plans.”

Specialty drugs represent an increasing percentage of insurance spending for prescription medications,” said Kev Coleman, head of research and data at HealthPocket, “and in coming years they’ll become the largest single cost category despite the fact that specialty drugs serve a minority of the population. For those dependent on these drugs, HealthPocket’s analysis found that comparing premiums and annual caps on out-of-pocket costs is often more important than comparing health plans' copayments and co-insurance fees for drugs.”

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