Reason Magazine’s blog post on the topic defines “specialty drugs” as “high-cost medications used to treat complex conditions such as multiple sclerosis.” Despite the high cost of these drugs, many people have used insurance that provided them with these needed medications at a low cost.
You know what is coming next, of course.
The Affordable Care Act has ended the era of insurance that actually pays for these specialty drugs.
The plans require users to pay coinsurance, a percentage of medication costs. While that percentage varies with specific plans and with the “metal” level of the plan, that’s expected to raise patients’ out-of-pocket payments higher than most are accustomed to paying.
Reason appeals to HealthPocket, an organization that rates plans.
An article published last summer pointed out, “When compared to the current individual and family health insurance market, both the entry-level Bronze Plan and the higher tier Silver Plan will increase most out-of-pocket drug costs for consumers.” Using Copaxone, a drug used to treat multiple sclerosis, as an example of a specialty medication, HealthPocket warned that “someone on the Bronze plan would have spent the $6,350 annual limit on out-of-pocket costs by the fourth month of coverage.”
But that is only if the drug is covered at all. Obamacare “requires only one drug per category and class be covered within a health plan formulary.” So if for some reason you are allergic to the medication that the insurance company picked, then you must pay the full price of the drug, while you are still stuck paying a higher price for the useless insurance.
So, by just looking at these important drugs, we see the issues that plague all of Obamacare. We see the theme of reduced choice is at work—just like Obamacare puts people in smaller networks with fewer hospitals, their drug options are reduced as well. And the expense of these drugs is representative of all of Obamacare’s plans and how impoverishing they are.