High Cost for Medications in Some States

With the passing of  the Affordable Care Act,  all Americans will now  have access to affordable health care.  Patients will be able to “shop” for coverage through utilization of their respective state’s insurance marketplaces.  Unfortunately, in some states  in the U.S.,  patients are nervous thinking about their prescription coverage and that said insurance marketplaces will discriminate against those patients with the highest medical need.

One example of these patients are cancer patients.  Depending on their state of residence, they could be facing high costs for their medications under the health care law.  Some states are permitting insurance companies to charge patients a very large share of the cost for their cancer medications.  This is being done to keep insurance premiums low.  These cancer medications can cost patients upwards of thousands of dollars a month.   One state currently allowing this is California.  In California, patients can pay up to 30% of the medication cost.

On the flip side: New York State is establishing flat dollar co-payments for patients’ medications, specialty drugs included. These co-payments are much less that the costs being paid in California.

Marketplace analysts are fearful that more states will follow California’s footsteps than New York’s.  This would result in the sickest of patients possibly not being able to afford their medications.

The Obama administration says that the increase in premium costs will be offset by tax credits as well as proposed limits on patients’ liability. Patients continue to wait and see; a full picture of the administration’s plan with specific costs and benefits will hopefully be released in detail this coming fall.

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