An Analysis of Exchange Plan Benefits for Certain Medicines

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A new report demonstrates that the majority of plans in the Health Insurance Exchanges are placing a significant out-of-pocket burden on patients with serious illnesses by requiring particularly high cost-sharing for all medicines used to treat certain conditions. Avalere analyzed 123 “silver” exchange plan formularies to evaluate tier placement. The analysis looked at all brand and generic drugs within 19 classes to determine the potential patient cost sharing burden for these medicines. The data show a substantial number of plans requiring high cost sharing for all medicines in several classes.