It can start by issuing guidelines to help exchange administrators recognize when a plan’s drug formulary focuses inappropriately on the sticker price of a medicine rather than the value that the drug delivers to the patient and the health care system.
Coverage of prescription drugs must also comport with accepted medical practice. At present, some exchange plans do not cover the standard single-tablet method of treating HIV, even though the regimen is considered “the most cost-effective treatment strategy,” according to a study published by the journal ClinicoEconomics and Outcomes Research.
Regulators should also require plans to consider newly approved medicines. These meds may have higher price tags than their older counterparts. If they’re more effective or quicker to treat a particular condition, though, they might be worth that higher price tag.
Finally, regulators should scrutinize plans with deductibles for branded medicines, but not for generics. For some patients, branded medicines may be medically necessary. Such deductibles are not needed to encourage the use of generics anyway, as they already account for 80 percent of prescriptions. In the end, the extra charges may result in patients receiving suboptimal care.
Obamacare was sold as a means of delivering affordable care to those who couldn’t get it previously. Yet the insurance available through its exchanges appears set to cut many chronically ill patients off from quality treatment. Americans must not stand for such rationing.
Sally C. Pipes is president, CEO and Taube fellow in health care studies at the Pacific Research Institute. She is the author of “The Cure for Obamacare” (Encounter, 2013).