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Analysis of Marketplace Cancer Drug Coverage Shows Consumers Face Information Barriers on Cost and Coverage
ACS CAN Recommends Policy Changes to Improve Patients’ Understanding and Access to Affordable Care
February 22, 2017
Washington, D.C., February 22, 2017—Cancer patients trying to select the best health insurance plan through the market places continue to face challenges in determining prescription drug coverage and cost-sharing information in prospective coverage, according to analysis released today by the American Cancer Society Cancer Action Network (ACS CAN). The analysis of 2016 marketplace formularies in six states: Alabama, California, Colorado, Nevada, New Jersey and Texas found coverage transparency has improved since 2014 with greater use of prescription drug formulary look-up tools, but significant barriers remain. Some of the report’s findings include:
- Transparency issues persist for patients: Although search tools on HealthCare.gov and some state marketplaces have improved, getting information about a drug plan’s formulary is still difficult, especially for intravenous medications.
- Patient cost-sharing is high: Most of the cancer drugs researched - including generics - were listed at the highest cost-sharing tier and may require patients to pay costly coinsurance rather than a flat copay.
- Coverage limits remain: Patients frequently face limits or restrictions - such as prior authorization, and quantity limits - on common cancer drugs.
ACS CAN recommends several policies that could improve drug coverage and transparency in any health care system. These include monitoring formularies to ensure plans are not discriminating against patients with high-cost conditions like cancer; encouraging copayments rather than coinsurance for prescription drugs; and requiring all drugs listed in formularies be clearly labeled with the associated cost-sharing amount or a cost range for coinsurance. Texas has taken important steps to achieve these consumer-friendly policies. Starting this year, plans are required to provide clear cost-sharing information for each covered drug.
“Having access to accurate, easy-to-understand information about which drugs are covered and the out-of-pocket cost for those drugs is essential for consumers trying to select the best health plan,” said Chris Hansen, president of ACS CAN. “Without that information, patients and survivors are unable to truly assess what coverage best meets their needs and may inadvertently select a plan that negatively affects their care.”
In 2017, an estimated 1.7 million Americans will be diagnosed with cancer and there are 15.5 million Americans alive today who are cancer survivors.
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