In 2013 some Americans will start choosing health insurance plans offered by the new state-run health insurance exchanges. Designed to lower prices and increase competition, the exchanges will surely help millions of people access affordable care. However, health insurance plans often do not adequately cover prescription medications, and we are eager to follow the effectiveness of the exchanges as applied to prescription drug pricing.
While we hope (and believe) that increased coverage will enable more Americans to take needed medications, we believe that many will not benefit from the increased coverage. The Obama administration’s loose guidelines pertaining to prescription drugs and essential health benefits mandate that they require only one drug per class – in other words one statin (to treat high cholesterol), one proton pump inhibitors (to treat GERD), one inhaled steroid (to treat asthma), and so on, must be covered.
For many this will not be a problem. If there is only one prescription you plan on taking, you should be able to find a plan that covers it. If, however, you are taking multiple medications, things could get a bit hairy. Just because two drugs are in the same class doesn’t mean they work with the same efficacy for a given person. For example, atorvastatin (generic Lipitor) may work better for cholesterol treatment than simvastatin (generic Zocor) for one person, and vice versa for another. Imagine how difficult it would be to find an insurance plan that covers all your drugs if you are on three or four medications!
Some states plan to address this potential problem by requiring that plans offer more extensive drug coverage. As of October, 2012, an analysis of eight benchmark plans shows that they cover about 62% of drugs available in different classes.
While the health insurance exchanges are meant to provide a competitive marketplace that lowers costs, it isn’t as simple as just choosing a plan that covers the most drugs. You need to make sure it covers your drugs (in addition to other specific health benefits). We hope that the insurance exchanges will help end America’s $317 billion prescription non-adherence problem, but we fear that the pharmacy coverage under Obamacare won’t be nearly enough.