Obamacare has given millions more Americans health insurance, but they have to pay more for prescription drugs than people with employer-sponsored plans.
The average person with a plan bought in a marketplace set up under the Affordable Care Act has to pay 46 percent of total drug spending, according to research published Monday in the journal Health Affairs. That’s significantly more than for people with coverage through their workplace, who have to pay 20 percent of the costs on average.
The result, wrote Emory University researchers Kenneth Thorpe, Lindsay Allen and Peter Joski, is that Americans with marketplace plans fill fewer prescriptions to avoid out-of-pocket costs and, as a result, experience more serious problems over the long run.
“Our results show that out-of-pocket expenses for medications in a typical silver plan are twice as high as they are in the average employer-sponsored plan, resulting in fewer prescriptions filled and refilled and in higher spending on other medical services,” the authors wrote.
The findings underscore existing disparities between Americans who have more generous health coverage through their employers and those who have to buy plans in the new insurance marketplaces.
A majority of non-senior Americans have employer-sponsored coverage, just as before the healthcare law was passed. But about 10 million of those who didn’t have insurance now have coverage through the new marketplaces, which is often less generous or imposes more out-of-pocket costs or limits on which doctors they may see.
The majority of Americans shopping in the marketplaces buy middle-grade “silver” plans, which cover about 70 percent of health costs. That’s less than what a typical employer-sponsored plan covers, although those with income low enough can get subsidies for their premiums or to help cover other cost-sharing.
One big reason for lower costs among employer-sponsored plans is that they typically don’t combine deductibles, the amount a patient must pay in a year before their coverage kicks in, for drug costs and other medical costs, whereas most silver plans do.
The discrepancy between employer coverage versus marketplace coverage can result in patients having to pay much more out of pocket if they lose an employer plan, especially if they have chronic health conditions.
The researchers found that patients with one chronic condition who switched to a marketplace plan would find their out-of-pocket costs increased by 126 percent. The sickest patients, those with four or more chronic conditions, would see a smaller increase in out-of-pocket payments since they already would face a lot of extra costs, but they would still pay $1,145 out of pocket every year.
For those patients with multiple conditions, there is major danger that they could incur even higher medical costs if they don’t take their drugs as prescribed, the researchers warned.
“For these patients, who are sicker than the average patient, adherence to a prescription drug regimen can reduce the rate of more expensive medical events over the long term,” they wrote.
