Drug prices are increasing due to the fact that many health insurers cover few prescriptions, including those that are old and should be priced very low, Scott Gottleib of the American Enterprise Institute writes in a post for Forbes.
What has changed most abruptly in recent years, Gottleib writes, is the type of coverage that insurers offer for branded drugs. Plans have substantially raised the amount of cost-sharing they require for drugs, and more often than not, they don't cover any kind of specialty drugs until the patient hits his or her deductible. Then there's the problem of a reduced number of specialty drugs that insurers cover. Translation: when a certain drug doesn't make a health plan's list, consumers are completely uncovered, the post says.
In his examination of Affordable Care Act plans that cover drugs to treat some debilitating diseases, Gottleib found many plans leave out a whole category of drugs that are essential to treating these diseases.
Gottleib then outlined the benefits to a high-deductible, "consumer-driven" health plan, which he says aims to expose consumers to the incremental cost of their healthcare choices. A consumer-driven plan would widen access to providers, he argues, and part of that opportunity comes from the savings that would be achieved when the market makes insurance more competitive by allowing consumers to choose from a larger variety of coverage.
"Obamacare extinguished competitive choices in favor of one federally mandated insurance design, and politically preferred outcomes," he writes.
A survey conducted in August revealed that specialty drug prices could rise 23 percent next year, and health plan xecutives have said that the trend of drug cost increases is putting pressure on their margins and their members. Both those factors, Gottleib says, have contributed to high deductibles, high premiums and hollow coverage.
To learn more:
- read the post