Consumers will pay more for specialty drug coverage

Healthcare consumers are willing to choose an expensive health plan if it covers specialty drugs for diseases such as cancer, multiple sclerosis and rheumatoid arthritis, according to a recent study published in the journal Health Affairs.

The study found that, assuming premium costs were equal, 78 percent of 270 people surveyed preferred a health plan with generous coverage of specialty drugs instead of a plan with monthly out-of-pocket spending that averaged $167 per month. That means healthy adults would rather pay an average $12.94 per month to receive coverage for specialty drugs.

"Given the value that people assign to generous coverage of specialty drugs, having high cost sharing on these drugs seemingly runs contrary to what people value in their health insurance," the study authors wrote. "Thus, the value that healthy people receive from generous coverage could be substantial, yet payers might not fully appreciate it when they decide which treatments are worth covering," the study authors wrote.

Insurers haven't yet realized the high value of specialty drugs because they increasingly have been shifting specialty drug's high costs to members by altering their benefit structures and causing patients to pay an extra 30 percent to 50 percent for medications, FierceHealthPayer previously reported. Regardless of whether insurers adapt their benefits to such findings, there's already a movement afoot to prevent this cost-sharing practice. About 20 states have introduced bills to limit insurers charging higher copays for specialty drugs for chronic illnesses, according to an earlier FierceHealthPayer story.

 To learn more:
- read the Health Affairs study (subscription required)

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