A new policy being proposed by the federal government could leave some patients with higher out-of-pocket drug costs, according to The New York Times.
Six things to know:
1. The proposal would reportedly apply to coverage sold on the ACA exchanges.
2. It would give health plans more flexibility regarding the amount patients are charged. Rather than count the patient's entire copayment amount for a brand-name drug toward the annual limit for out-of-pocket costs, insurers under the proposal would only have to count the smaller amount that would be charged for the drug's generic version, the Times reported. This means patients who use brand-name prescription drugs when there are available cheaper generic versions could have to pay more before reaching the annual limit on out-of-pocket costs.
3. Under the Trump administration's proposal, insurers would also not have to count coupons and other financial assistance that drug manufacturers provide patients if there are available generic versions, the report states.
4. According to the Times, federal officials said of the proposal: "The availability of a coupon may cause physicians and beneficiaries to choose an expensive brand-name drug when a less expensive and equally effective generic or other alternative is available. When consumers are relieved of copayment obligations, manufacturers are relieved of a market constraint on drug prices."
"Coupons can add significant long-term costs to the healthcare system that may outweigh the short-term benefits," they added.
5. Groups representing patients have expressed concerns about the proposal.
Bari Talente, executive vice president of the National Multiple Sclerosis Society, told the Times, "Many people with MS rely on co-pay assistance, even for generic medications."
Additionally, Carl Schmid II, deputy executive director of the AIDS Institute, told the publication patients who take a drug to treat HIV could see significantly higher out-of-pocket costs under the Trump administration's proposal.
6. As the Trump administration addresses prescription drug prices, it has also proposed a new method of calculating inflation in insurance coverage prices, the Times reported. According to the publication, this factor is used to determine the amount of premium subsidies and the annual limit on patients' out-of-pocket costs. Federal officials estimate $900 million in annual government savings in subsidies in 2020 and 2021 as a result of the changes.
Read the full Times report here.
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