Kaiser Survey Shows Dramatic Growth in Pharmacy Copayments

The Kaiser Family Foundation and the Health Research & Educational Trust (HRET) released the 2010 Employer Health Benefits Survey this month and while the "headline" showed average premiums increasing only 3% -- the real news is that families are seeing significant increases in out-of-pocket costs including deductibles, copayments and tiered copays that esclate the cost share for more costly drugs and services,

Since 2005, workers’ contributions to premiums have gone up 47 percent, while overall premiums rose 27 percent, wages increased 18 percent, and inflation rose 12 percent. Many employers are also raising the annual deductibles workers must pay before their health plans begin to share most health care costs. A total of 27 percent of covered workers now face annual deductibles of at least $1,000, up from 22 percent in 2009.

Of particular note, one in 8 employers now have 4 tiers for drug benefit copayments a trend which has doubled in just 2 years. Such tiers often leave families with overwhelming copayments for chronic and/or high cost biologicals.

The nation’s recession contributed to the shift in burden to workers. In response to the economic downturn, 30 percent of employers say they reduced the scope of health benefits or increased cost sharing, and 23 percent report increasing the amount employees pay for coverage, the survey finds. A summary of the study can be found at http://ehbs.kff.org/pdf/2010/8086.pdf

Health Reform Could Increase Medigap Cost-Sharing for Seniors

Patient advocates are expressing new concerns that the language in the health reform bill will hit Medigap plans with higher cost-sharing requirements and would likely lead to increased copays starting in 2015 for the two most popular types of Medigap plans, Plans C and F.

Some health care experts worry the provisions, targeted for their savings and the hope that extra out-of-pocket costs will reduce unnecessary medical services, would unfairly hurt patients newly enrolling in the program.

Currently, Medigap policies pay the full 20 percent of cost-sharing for physician care and other outpatient Part B services, but the new law indicates that patients have to pay some of the cost sharing in order to reduce unnecessary medical care. Since there is no cap on the Medicare Part B copayment, many seniors prefer Medigap plans C and F as they cover all of those costs. Such coverage is critical for chronically ill patients and cancer patients.

Clearly, this will be one several key issues that impact patient copayment exposure and related access to care.