8 BZBEHIND28 MURRAY
An adjustment to the Affordable Care Act will ensure New Jerseyans won't pay exorbitant prices our of pocket for prescription medication.
(Ed Murray/The Star-Ledger)
By Lisa Schill
More than 200,000 Garden State residents have signed up for health coverage through the insurance exchange created by the Affordable Care Act.
That figure is encouraging, but the quality of coverage they're receiving is not. The available plans often strap enrollees with hundreds or even thousands of dollars of out-of-pocket medical expenses.
Fortunately, federal regulators just stepped in to address this shortcoming in the Affordable Care Act. They have issued a new ruling that ensure enrollees in New Jersey's insurance exchange plans get the protection they deserve and the medication they need.
Across the country, people were unknowingly enrolling in insurance plans that conceal the exorbitant out-of-pocket costs they will have to pay for medications. That's because these medicines come with unaffordable "co-insurance," which requires patients to pay a set slice of the product price -- no matter how high it is.
The costs are particularly unaffordable for people with chronic conditions, such as cancer, diabetes and HIV/AIDS.
Rather than pay these exorbitant sums, some patients will simply skip their medications. By not taking prescriptions, though, they increase their risk of acute illnesses that require even more expensive treatments.
This new ruling from federal officials will address many of these shortcomings and ensure that Affordable Care Act plans don't skimp on drug coverage.
First, the rule advises insurance companies to base their coverage of particular drugs on the recommendations of expert panels and other objective criteria. Doing so inhibits insurers from making decisions that discriminate against people with certain illnesses.
The rule also increases plan transparency. Plans are now required to publish full, up-to-date formularies online. That will allow patients to shop for plans based on their medication needs and avoid unexpected out-of-pocket costs.
If patients need a medication not covered by their plan, they can apply for an exception. Now, thanks to the new rule, insurers must respond to those patients within three days.
These reforms are a good start. But there's still more federal authorities can do to ensure the exchanges actually fulfill their mission of extending affordable health coverage to vulnerable patients.
At the very least, regulators should outright prohibit insurers from offering plans that impose large out-of-pocket payments for key medications.
Regulators also ought to ban co-insurance altogether for lower-income individuals eligible for subsidized ACA plans. These people simply can't afford huge and unexpected co-insurance payments.
This new ruling will greatly improve the quality of care afforded New Jersey residents enrolled in our state's exchange. Federal regulators deserve credit for making these improvements to the Affordable Care Act. But there's still more work to be done.
Lisa Schill is vice president of RASopathies Network USA.
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