The out-of-pocket costs for specialty drugs under ObamaCare has increased by 16% in just the past year – from 2016 to 2017- according to a recent report released by HealthPocket.
ObamaCare plans cover certain prescription drugs, but not all drugs that patients may require. As HealthPocket notes, “For a plan to help pay for a drug, the drug must first be included on the health plan’s formulary … Drugs that are off-formulary are not only paid for completely out-of-pocket by the enrollee but those expenses do not count towards the annual cap on out-of-pocket spending.”
The report also discovered that for ObamaCare’s silver plan, the specialty drugs required to treat arthritis and Crohn’s disease would cost patients $1,889.6 in out of the pocket costs. And, since 2017, such costs have already increased an additional $262.45. Similarly Harvoni, a drug to treat Hepatitis C patients which costs $12,590.60 in out of pockets costs was increased by an astonishing $1,762.59 in just one year.
“Compared to the coinsurance rate for 2016, average cost-sharing for specialty drugs on silver plans rose 16% in 2017,” the report states. “This increase in monthly out-of-pocket costs for the top five specialty drugs ranged from $226.29 to $1,762.59. The average cap on yearly out-of-pocket costs on 2017 silver plans is $6,449 for an individual and $12,952 for families.”
The report also noted that, “recent political debate on continuing $7 billion in annual cost-sharing subsidies largely ignored other substantial issues regarding Affordable Care Act out-of-pocket expenses … Aside from matters such as deductibles faced by unsubsidized enrollees, there are also enduring concerns regarding out-of-pocket costs for prescription medications.”
The head of research at HealthPocket, Key Coleman, issued this warning, “As out-of-pocket costs for specialty drugs continue to be a problem without resolution, consumers taking these medications need to be vigilant in their insurance shopping.” He also advised consumers that, “cost-sharing for specialty drugs and annual caps on out-of-pocket expenses can be even more important factors than premiums when financially comparing health plans.”
Republican attempts to repeal, or simply patch Obamacare have all failed – despite numerous repeal attempts during Obama’s administration. Keep in mind, using a rare budgetary procedure called, “reconciliation,” both the House and the Senate were able to put an Obamacare repeal on President Obama’s desk – and while it was vetoed, it’s shocking that the Republicans cannot do the same thing, with more members in the House, and the Senate, especially now that a Republican is president.
