Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs
Language: 
English
Short Title: 
Comparing employer-sponsored and federal exchange plans
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 employer-sponsored 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.

Author(s): 
Buttorff, Christine
Andersen, Martin S.
Riggs, Kevin R.
Alexander, G. Caleb
Item Type: 
Journal Article
Publication Title: 
Health Affairs (Project Hope)
Journal Abbreviation: 
Health Aff (Millwood)
Publication Date: 
2015-03
Publication Year: 
2015
Pages: 
467-476
Volume: 
34
Issue: 
3
ISSN: 
1544-5208
DOI: 
10.1377/hlthaff.2014.0615
Library Catalog: 
PubMed
Extra: 
PMID: 25732498

Turabian/Chicago Citation

Christine Buttorff, Martin S. Andersen, Kevin R. Riggs and G. Caleb Alexander. 2015-03. "Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs." Health Affairs (Project Hope) 34: 3: 467-476. 10.1377/hlthaff.2014.0615.

Wikipedia Citation

<ref> {{Cite journal | doi = 10.1377/hlthaff.2014.0615 | issn = 1544-5208 | volume = 34 | pages = 467-476 | last = Buttorff | first = Christine | coauthors = Andersen, Martin S., Riggs, Kevin R., Alexander, G. Caleb | title = Comparing employer-sponsored and federal exchange plans: wide variations in cost sharing for prescription drugs | journal = Health Affairs (Project Hope) | date = 2015-03 | pmid = | pmc = }} </ref>