Comparing employer-sponsored and federal exchange plans

Wide variations in cost sharing for prescription drugs

Christine Buttorff, Martin S. Andersen, Kevin R. Riggs, George Caleb Alexander

Research output: Contribution to journalArticle

Abstract

Just under seven million Americans acquired private insurance through the new health insurance exchanges, or Marketplaces, in 2014. The exchange plans are required to cover essential health benefits, including prescription drugs. However, the generosity of prescription drug coverage in the plans has not been well described. Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum). Our secondary objective was to compare the exchange coverage to employersponsored coverage. Analyzing prescription drug benefit design data for the federally facilitated exchanges, we found wide variation in enrollees' out-of-pocket costs for generic, preferred brand-name, nonpreferred brand-name, and specialty drugs, not only across metal tiers but also within those tiers across plan types. Compared to employer-sponsored plans, exchange plans generally had lower premiums but provided less generous drug coverage. However, for low-income enrollees who are eligible for cost-sharing subsidies, the exchange plans may be more comparable to employer-based coverage. Policies and programs to assist consumers in matching their prescription drug needs with a plan's benefit design may improve the financial protection for the newly insured.

Original languageEnglish (US)
Pages (from-to)467-476
Number of pages10
JournalHealth Affairs
Volume34
Issue number3
DOIs
StatePublished - 2015

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Cost Sharing
Prescription Drugs
Health Insurance Exchanges
Names
Preferred Provider Organizations
Metals
Pharmaceutical Preparations
Health Maintenance Organizations
Drug Design
Insurance Benefits
Health Expenditures
Platinum
Insurance
Silver
Gold

ASJC Scopus subject areas

  • Health Policy

Cite this

Comparing employer-sponsored and federal exchange plans : Wide variations in cost sharing for prescription drugs. / Buttorff, Christine; Andersen, Martin S.; Riggs, Kevin R.; Alexander, George Caleb.

In: Health Affairs, Vol. 34, No. 3, 2015, p. 467-476.

Research output: Contribution to journalArticle

Buttorff, Christine ; Andersen, Martin S. ; Riggs, Kevin R. ; Alexander, George Caleb. / Comparing employer-sponsored and federal exchange plans : Wide variations in cost sharing for prescription drugs. In: Health Affairs. 2015 ; Vol. 34, No. 3. pp. 467-476.
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