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Cost sharing for Rxs a growing burden.

WASHINGTON -- A new report demonstrates that most plans in the health insurance exchanges are placing significant out-of-pocket demands on patients with serious illnesses by requiring particularly high cost-sharing for all medicines used to treat certain conditions.

This analysis by Avalere Health finds that the vast majority of plans in the health insurance exchanges call for significantly high cost sharing for all medicines in at least one class and that this cost burden leaves many patients with nowhere to turn and can negatively affect patients' health by limiting access to needed care.

The report, which was commissioned by the Pharmaceutical Research and Manufacturers of America (PhRMA), is based on Avalere's analysis of 123 exchange plan formularies, including plans in all states. Avalere analyzed cost sharing and formulary tier placement for all brand and generic drugs within 19 prescription drug classes.

Patients' cost sharing for prescription drugs typically comes in the form of a co-pay (a fixed-dollar amount) or co-insurance (calculated as a percentage of the total cost of the drug.)

Health plans also place covered medicines in tiers--typically there are four or five tiers--with the lowest tier requiring a low co-pay ($15 for example) and the highest tiers often requiring a co-insurance of 40% or more.

The Avalere findings reveal that in seven of 19 classes of medicines for serious illnesses, including cancer; HIV/AIDS; autoimmune diseases such as rheumatoid arthritis and multiple sclerosis; and bipolar disorder, more than 20% of Silver plans require co-insurance of at least 40% or more for all drugs in those classes.

Similarly, in 10 of the 19 selected classes, a minimum of 20% of Silver plans require co-insurance of 30% or greater for drugs in the classes.

The study also finds that more than 60% of Silver plans place all covered medications for multiple sclerosis, rheumatoid arthritis, Crohn's disease and certain cancers in the plan's highest formulary tier. For HIV/AIDS therapies, about 25% to 35% of plans place all covered medications on the highest tier.

"The exchanges were meant to provide patients access to the medicines they need, especially for the sickest among us. Yet this report paints a very different picture, one in which many Americans still find themselves unable to access the care they desperately need due to high out-of-pocket costs," commented John Castellani, president and chief executive officer of PhRMA.

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Title Annotation:RX RETAIL PHARMACY: Branded Drugs
Publication:Chain Drug Review
Date:Jul 7, 2014
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