January 21, 2015

Confusing Information on the Cost of Specialty Drugs

Washington DC Update - Learn What's Happening in the Policy Arena for CYSHCNAn analysis by the health care consulting firm Avalere finds that new benefit designs and a lack of clear information from HealthCare.gov are making it difficult for consumers to determine their out-of-pocket costs for specialty drugs in exchange plans. See the report here.

According to a synopsis from Avalere, “HealthCare.gov reports formulary cost sharing for all plans in a four-tier structure (including only one specialty tier); however, about 35 percent of Silver plans do not use four-tier formularies. Because of this discrepancy, consumer costs appearing on HealthCare.gov may misstate actual enrollee financial responsibility.”