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Insurers increase cost-sharing measures for specialty drugs


Insurers are adopting more cost-sharing measures, especially coinsurance, to shift the costs of expensive specialty drugs onto consumers who purchase plans sold on health insurance exchanges, according to a new analysis from Avalere Health.

The consulting firm found that silver plans charging coinsurance greater than 30 percent for specialty meds have risen from 27 percent in 2014 to 41 percent in 2015. All told, 80 percent of silver plans use coinsurance as a consumer cost-sharing tool for specialty medications, though the amount is often less than 30 percent.

Consumers enrolled in exchange plans are 59 percent more likely to use specialty drugs than people with employer-based coverage. That's particularly true of medications that treat HIV and hepatitis C.

"Health plans continue to focus on managing drug costs to keep premiums low," Avalere CEO Dan Mendelson said in the analysis. "Competitive premiums are key to a sustainable exchange marketplace, which has led plans to pursue more significant cost-sharing. In some cases this could make it difficult for patients to afford and stay on medications."

Although specialty drugs comprise just 1 percent of all prescriptions, they account for 25 percent of spending on all drugs, reported Kaiser Health News. But insurers are pushing back against the rising costs of specialty meds, especially hepatitis C drug Sovaldi.

America's Health Insurance Plans slammed the drug industry for the soaring costs of specialty meds such as Sovaldi because it's taking unfair advantage of insurers, FierceHealthPayer previously reported.

To learn more:
- read the Avalere Health analysis
- see the Kaiser Health News article

Related Articles:
Insurers figure out ways to cover pricey treatments
Specialty drugs 59% more common in exchange plans, study finds
60 Minutes spotlights rising drug costs
AHIP slams pharma for taking advantage of insurers
Benefits plans excluding more drugs as costs rise
Insurers urge Gilead rivals to discount hep C drugs