A recent report led by researchers at the Rollins School of Public Health at Emory University shows that out-of-pocket expenses for medications within the most popular health insurance Marketplace plan—the silver plan—are twice as high as the average employer-sponsored health plans. According to the report these high costs can lead to higher spending for other medical services since fewer prescriptions would be filled in a typical silver plan compared to an employer plan.  Researchers provide their recommendations in the October edition of Health Affairs.

Led by Kenneth E. Thorpe, PhD, Robert W. Woodruff professor and chair of the Department of Health Policy and Management, the research team believes that maintaining the use of cost-effective prescription medications could require lower cost sharing for patients with chronic conditions than what is currently found in the Marketplaces.

"For all chronic conditions, individual out-of-pocket spending on drugs would rise if patients switched from an employer-sponsored plan to a silver plan," explains Thorpe. "Total drug cost averages among patients with any one of the ten chronic conditions studied are predicted to rise 105 percent, from $304 to $621 annually. Patients in all of the chronic condition groups would see an increase in out-of-pocket drug spending while patients with hypertension, cancer, arthritis, dyslipidemia, or a pulmonary disorder could expect to approximately double. This results in the poorest health outcomes for patients with one or more chronic condition and in turn, an increase in medical care."

The report also highlights the need for a value-based health insurance benefit and cost sharing design emphasis to reduce cost sharing in situations where medical treatment is critical for maintaining health in clinically indicated services.

Thorpe notes, "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 should be an important health insurance priority."

The complete report is available at:http://content.healthaffairs.org/content/34/10/1695.abstract