Dive Brief:
- A new report released by the Robert Wood Johnson Foundation has illustrated significant variability in the level to which ACA marketplace plans provide coverage for antidepressants.
- They add marketplace customers lack consumer-friendly, transparent tools and information to help them navigate and understand their options for antidepressant coverage.
- For the analysis, RWJF researchers looked at antidepressant coverage, cost-sharing requirements and transparency in Alabama, California, Florida, Maryland, and Minnesota. The states were selected for their location, benchmark plan generosity, and mix of state-based and federally facilitated marketplaces, the foundation says.
Dive Insight:
The report found between 2005 and 2008, 11% of Americans age 12 and over were taking antidepressants, making them the third most commonly used prescription drug class, and noted it can require trial and error with multiple antidepressants before patients find one that works for them.
That makes the case that patients' access should not be limited. "A narrow formulary may prevent patients from getting the prescriptions they need," the report stated.
Among the report's key points: Seventy-four percent of insurers in the study exclude one to five antidepressants from their formularies, and some exclude as many as 15.
The authors suggest to assist patients, marketplaces should display and link directly to plan formularies, as well as communicate factors including co-pay, price tiers, and prior authorization requirements.