New Study Shows High Deductibles in Exchanges Single Out Patients Who Need Medicines

New Study Shows High Deductibles in Exchanges Single Out Patients Who Need Medicines

05.15.14 | By

Our member companies strive every day to bring innovative new medicines and treatments into the market to improve the lives of patients, both in the United States and abroad.  Access to high-quality medicines is our common goal and top priority. Unfortunately, some health plans now being offered make it more difficult for people to get access to the medicines they need.

The Health Insurance Exchanges present a number of challenges because their high deductibles and cost sharing for medicines put patient health at risk and increase costs. This was evident in a new study released today by PhRMA and conducted by Milliman, Inc. According to the report, Silver exchange plans, which a majority of enrollees have selected, are often not comparable to typical plans sponsored by employers, leaving exchange enrollees potentially paying more than twice as much out of pocket for medicines as they would in an employer plan.

For patients with cancer, multiple sclerosis and other debilitating, chronic diseases, exchange plans simply won’t work. There is currently no federal requirement for the exchanges to cover or even review new medicines as they come to market, potentially prohibiting patients from getting the innovative treatments they need. Additionally, individuals suffering from these conditions are subject to greater cost sharing and there is concern about patient out-of-pocket expenses for prescription medicines, especially considering 46 percent of Silver plans have a deductible for all health spending including medicines. Typically this kind of deductible requires patients to pay around $2,000 out of pocket before prescriptions are covered.

Hindering access to the medicines patients need and deserve will only be a burden to individuals and the economy. Patient adherence is one of the best ways to improve health outcomes and generate cost-savings in our health care system. Some silver exchange plans do just the opposite because higher out-of-pocket expenses have already been shown to decrease patient adherence to the medicines and treatments they need and deserve.

We believe the findings from this study demonstrate how critical it is to put patients first and not burden them with high cost sharing that creates barriers to maintaining their health. PhRMA and our members are committed to patients and to working with insurance companies and other stakeholders to find solutions that ensure such lifesaving medicines reach those who need them the most.

Press Release: Many Patients with Exchange Coverage to Pay More than Twice As Much Out Of Pocket for Prescriptions Compared to Employer Plans


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