Insurers say prescription drugs are one of the main reasons health care costs are rising.
“Spending on specialty drugs is growing rapidly. It’s unsustainable,” said Clare Krusing, spokeswoman for America’s Health Insurance Plans, a trade group that represents the private insurance industry.
Only 1 percent of prescriptions written in 2012 were for specialty drugs, but they accounted for 25 percent of the total cost of prescription drugs, according to a study by America’s Health Insurance Plans.
Insurers can generally choose to put whichever drugs they want into the specialty tier of a plan. Generic drugs for blood pressure or cholesterol typically fall into categories that require patients to pay less than $20 out-of-pocket. But patients can end up spending significantly more when they pay for a percentage of a specialty drug’s cost. Two of the most frequently prescribed specialty drugs in recent years include the cancer drug Avastin, with an $11,000 average annual price per patient, or the hypertension drug like Letairis, which costs $32,000 per year, according to health insurers.
Even before the Affordable Care Act took effect, insurers had increasingly begun requiring patients to pay a percentage of the drug costs instead of a flat co-pay, but experts say patients often spend more for their prescriptions in plans offered under the health law because of the co-insurance.
“There’s a significant percentage of plans who are using co-insurance of 50 percent or higher,” said Caroline Pearson, who tracks the health care overhaul for Avalere Health, which studied plans in 19 states. “It is generally a lot higher than what we see in private insurance.”