- “Maintaining the use of cost-effective prescription medications might require lower cost sharing for patients with chronic conditions than is currently found in the Marketplaces” created under the Affordable Care Act, researchers from Emory University in Atlanta concluded in a recent Health Affairs article.
- The researchers compared cost-sharing and prescription/medical costs for individuals with health insurance plans through an employer to such spending in a “typical silver plan” through the marketplaces set up under the ACA.
Patients with one chronic condition who switched coverage to a typical silver plan from an average employer plan would experience the largest percentage for an out-of-pocket increase (126%) but would pay less on average ($396 annually) than those with more chronic conditions. Individuals with four or more chronic conditions “would see the smallest percentage increase in out-of-pocket payments but would pay $1,145 out of pocket annually,” the researchers found.
The researchers noted the silver Marketplace plan has higher cost sharing than a typical employer-sponsored plan, which “may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions.”
Kenneth Thorpe, the study’s lead author and chair of the health policy department at Emory, told Kaiser Health News the report “underscores the need for people to consider more than the premium when they compare health plans on an exchange.”
The authors acknowledge cost sharing for prescription drugs is only one issue in a larger discussion on value-based health insurance benefits. They point to economist Kenneth Arrow who stated in his discussion on moral hazard and optimal coinsurance design that the value of insurance rises with the uncertainty of the health risk.
“Designing cost sharing in health plans that both addresses the moral hazard challenge and encourages the use of clinically recommended services through low or no cost sharing for patients with chronic conditions is an important health insurance priority,” the researchers wrote.