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Out-of-Pocket Costs for Specialty Drugs Rise 16% Under Obamacare

Costs for specialty drugs in Obamacare plans that must be paid for by the consumer increased 16% from 2016 to 2017, according to HealthPocket – Newsline writes.

“Compared to the coinsurance rate for 2016, average cost-sharing for specialty drugs on silver plans rose 16 percent in 2017. This increase in monthly out-of-pocket costs for the top five specialty drugs ranged from $226.29 to $1,762.59,” the report said.

Prescription drug coverage is standard under Obamacare, but the plans do not pay for all medications.

“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 HealthPocket report said.

The average copay for specialty drugs is $346.49 for an Obamacare bronze plan, $261.55 for a silver, $172.57 for a gold plan, and $92.46 for a Platinum plan, the report said.

Kev Coleman, the head of research and data at HealthPocket, said that consumers must be careful when shopping for insurance, because of those out of pocket costs.

“For these consumers, 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,” Coleman said in the report.

The study was obtained from data records of 2017 Obamacare health insurance plans offered in 50 states and Washington, D.C., and was obtained on Aug. 27, 2017, the report said.

Coleman noted in the report that Obamacare plans have maximums on how much customers must pay out of pocket for health services and medications. In 2017, that number for a Bronze plan was $6,449 for an individual and $12,952 for a family,

High-deductible plans are a way to control rising costs of healthcare by moving more of the financial risk from employers to workers, according to The Miami Herald.

“If you’re paying more of the price of healthcare, then you’re going to be using it more carefully,” said University of Miami healthcare policy expert Steven Ullmann in The Herald.

Out-of-Pocket Costs for Specialty Drugs Rise 16% Under Obamacare - overview

Summary: Costs for specialty drugs in Obamacare plans that must be paid for by the consumer increased 16 percent from 2016 to 2017, according to HealthPocket.

“Compared to the coinsurance rate for 2016, average cost-sharing for specialty drugs on silver plans rose 16 percent in 2017. This increase in monthly out-of-pocket costs for the top five specialty drugs ranged from $226.29 to $1,762.59,” the report said.

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