OBAMAmess: Cancer Patients Paying More for Medication Next Year

People with Obamacare coverage who take medications for cancer, HIV, multiple sclerosis, and other chronic diseases might pay more out of pocket next year. A greater share of insurance plans sold in the healthcare.gov marketplace will require consumers to pay 30 percent or more of the cost of specialty drugs, according to a new analysis from consultant Avalere Health.

Cost sharing is one of the ways insurers can limit premiums. Patients pay for a greater portion of the medical care they need through deductibles, co-pays, and co-insurance. That last technique splits the bill for medical care, with patients paying a fixed percentage of the total cost and the insurance plan picking up the rest.

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Avalere looked at how much cost sharing was required for drugs insurers considered “specialty” medicines. There’s no consistent definition of specialty drugs; the term generally refers to medicine used to treat severe or rare illnesses. The doses can cost thousands of dollars a month. Asking patients to pay 30 percent of that can mean some people skip doses they can’t afford.

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