As prescription drug costs continue to rise, ensuring that consumers have access to the drugs they need is a growing concern. Insurers blame the drug companies for high prices while drug companies blame insurers for restrictive plans. Consumers are stuck in the middle picking up a higher聽tab. Now a 聽highlights strategies for states聽to help consumers in this tug of war.
The report,聽by a group of patient and consumer advocates who are聽representatives to the (NAIC), is being released today and will be presented this weekend at the summer meeting of the NAIC.
鈥淪tates are moving ahead,鈥� said Katie Keith, an attorney who works with the NAIC consumer representatives and helped write the report. 鈥淭here are best practices out there and states are making changes.鈥�
The report describes steps聽states聽can take to address a number of drug-coverage issues in the commercial insurance market, including:
- Limiting the number of cost-sharing tiers that insurers can use in a plan. Standardized plans in Massachusetts, New York and Vermont that are offered on the health law鈥檚 insurance marketplace are limited to three tiers.
- Limiting consumer out-of-pocket spending by, for instance, prohibiting plans from charging coinsurance, which is a percentage of the cost of a drug, instead of using flat dollar copayments. In Montana, for example, insurers have to offer at least one marketplace plan at the silver level or higher that charges only copayments in all drug tiers.
- Prohibiting plans from changing their formulary, or list of covered drugs, midway through the year. Texas and Nevada have prohibited most formulary changes, while other states have limited changes and some required insurers to notify consumers when changes are made.
The scope of the strategies vary. Some apply to the individual and small group markets only, others affect large group plans that are fully insured.
鈥淪tates have long played this role, trying to make policies that work for consumers,鈥� said Keith.
鈥淚t鈥檚 more urgent now with all the crazy drug prices we鈥檙e seeing.鈥�
The NAIC develops model laws and regulations on various subjects that states can use as templates for their own rule-making. This report is intended to inform NAIC members as they move to revise the existing model law, the ,聽which was last updated in 2003, Keith said.
This story was updated to clarify Katie Keith鈥檚 work with NAIC.
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