New ObamaCare enrollees are going to find it difficult to access many prescription drugs, says Sally Pipes, president of the Pacific Research Institute.
Those who enrolled in the health care exchanges may be in for a surprise once they start looking at their policies. Placing limits on drug coverage is seen as a way to keep insurance costs down. But if drug coverage is stingy, patients may simply forgo treatment altogether, turning treatable conditions into expensive problems that ultimately mean higher costs, for the individual as well as the entire health care system.
According to the Journal of Clinical Oncology, cancer patients facing higher copayments were 70 percent more likely to simply stop taking their cancer treatment and 42 percent more likely to skip doses.
This is not only a problem for patient health, but for health care spending as a whole. According to Frank Lichtenberg, professor at Columbia University, for every $1.00 spent on drugs, hospital spending is reduced by $3.65.
All exchange plans must cover prescription drugs, and the average plan covers more than 50 percent of all medicines. However, prescription drug “coverage” does not mean that the drugs are affordable.
There are two ways that prescription drugs are generally paid for: copays (in which the insured make a flat payment toward the cost of any prescription) and coinsurance (in which the insured pay a percentage of the total drug bill).
In the exchanges, most cheaper, generic drugs require copays, while more expensive, brand-name drugs require coinsurance.
Coinsurance can be very expensive. Gleevec, a common cancer drug, has coinsurance rates in the exchanges of up to 30 percent, leaving patients to foot a $2,000 monthly drug bill.
Patients who need specialty drugs are affected the most, because those are the drugs that have high coinsurance rates.
In all, drug cost-sharing under ObamaCare is 34 percent higher than in policies prior to the law.
The Affordable Care Act may have given enrollees access to insurance, but not to affordable care.