HealthPocket study finds copayments, coinsurance fees for drugs rise under ACA

March 18, 2014

An examination of new health plans from 46 states revealed that copayments and co-insurance fees for drugs increased an average of 34% as compared to the pre-Affordable Care Act (ACA) individual insurance market.

Sunnyvale, CA-An examination of new health plans from 46 states by HealthPocket revealed that copayments and co-insurance fees for drugs increased an average of 34% as compared to the pre-Affordable Care Act (ACA) individual insurance market.

All 4 new health plan categories under the ACA had drug cost-sharing increases. Bronze health insurance plans had the highest increase, 58%, while Platinum health insurance plans had the lowest increase, 15%.

Plan enrollees who use brand-name drugs and specialty drugs face the greatest burden from the increases in copayments and co-insurance fees. Those enrollees who use medications infrequently, on the contrary, are not likely to notice the cost-sharing increases.

The 34% increase in copayments and co-insurance fees does not mean that consumers will spend 34% more on drugs. Drug spending is also affected by multiple factors including deductible amounts, out-of-pocket caps, and what drugs are included within a health plan's list of covered medications.

Prior to the ACA, nearly 1 out of 5 health insurance plans purchased privately by individuals and families lacked prescription drug coverage. In comparison, all new health plans in the individual market include a drug benefit. In addition, some over-the-counter drugs such as aspirin, folic acid, and iron supplements can be obtained without any out-of-pocket cost when used as preventive medicine.

"With copayments and co-insurance fees rising, consumers must shop health plans more carefully. Copayments, deductible amounts, and limits on annual drug spending should not be ignored," said Kev Coleman, head of research and data at HealthPocket. "Consumers can also discuss with their doctors whether there are alternative drugs that have lower costs but equivalent therapeutic results."