Americans with chronic illnesses—who are expected to be among the biggest beneficiaries of the health law—face widely varying out-of-pocket drug costs that could be obscured on the new insurance exchanges.
Under the law, patients can't be denied coverage due to existing conditions or charged higher rates than healthier peers. The law also sets an annual out-of-pocket maximum of up to $6,350 for individuals and $12,700 for families, after which insurers pay the full tab.
But depending on the coverage they select, some patients on expensive drug regimens could reach that level fast. Some medications for conditions including hepatitis, rheumatoid arthritis, HIV and cancer can retail for thousands of dollars a month, and some plans require patients to pay as much as 50% of the cost.
The HIV drug Atripla, for example, typically retails for about $2,200 a month. On "silver," or midlevel, plans in Miami-Dade County, Fla., with comparable premiums, monthly out-of-pocket costs for Atripla range from $55 on Molina Marketplace Silver to $902 on Cigna Corp.'s Health Flex 1500. On a single Cigna plan, Health Savings 3400, out-of-pocket costs for Atripla vary from zero if patients buy from an in-network pharmacy to $1,127 if they don't.
http://online.wsj.com/news/articles/SB10001424052702303722104579238263770197936
In a study of 22 carriers in six states, Avalere Health found that 90% of bronze plans (with generally the lowest premiums) require patients to pay a percentage of costs, 40% on average, for drugs in tiers 3 and 4, compared with 29% of employer-sponsored plans that most Americans currently use. Most silver plans also require patients to pay 40% for the highest-tier drugs, although some have flat fees of $70 to $270, the study found.
= new reply since forum marked as read