NCPA - National Center for Policy Analysis

High Coinsurance Rates Mean High Drug Costs for Patients

March 5, 2014

Before ObamaCare was put in place, insurers had started moving from fixed-dollar copayments toward a percentage model for specialty medicine costs because of the high costs of new drugs, which can cost up to $100,000 per year just for one patient. Those coinsurance rates have begun rising, says Reuters.

  • Brian Rosen, senior vice president for public policy at the Leukemia & Lymphoma Society, said "In the past, we've seen 10 or 20 percent coinsurance rates. Now we're seeing 30, 40 and 50 percent. So patients are being asked to bear more of the cost."
  • Studies of various health plans indicate that consumers may be responsible for up to 50 percent of the cost of specialty drugs -- drugs that can cost $8,000 or more each month.
  • The higher coinsurance rates are also used by insurance companies to lower monthly premiums to attract healthy enrollees.

These high rates have consequences for the chronically ill, who rely on these specialty drugs.

  • Morgan notes that some bronze-level plans do not charge coinsurance for specialty drugs, yet they contain high deductibles at or near ObamaCare's cap on out-of-pocket expenses of $6,350 for individuals and $12,700 for families.
  • A study from Avalere Health, a consulting firm, found that 59 percent of silver plans and 38 percent of platinum plans had coinsurance rates for specialty drugs. Sixty percent of bronze plans had coinsurance rates above 30 percent.
  • Forty-year-old Lupus sufferer Emilie Lamb, who voted for Obama, called the new health law disastrous, saying that it should be repealed. Her previous health plan cost $53 per month in premiums with copays that added up to $1,000 per year. She now has to pay $373 in monthly premiums, with no deductible, but the higher cost has forced her to take a second job.

Source: David Morgan, "Chronically Ill Facing High Drugs Costs under U.S. Health Law," Reuters, February 28, 2014.


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