Drugs expensive under plans sold on health exchange, survey finds

Is health reform too expensive?

The Affordable Care Act is not so affordable for many Marylanders, according to a new survey.

The landmark law that was supposed to make insurance available to hundreds of thousands of people without coverage is costing Marylanders so much more in prescription drug costs that it may deter patients from taking their medicine, the survey by the Partnership to Fight Chronic Disease found.

During an event Tuesday to announce the survey results, one mental health advocate said a patient who called her group described her health plan as "worthless" and said it cost less to buy medicine directly from the drugstore using coupons and other discounts.

"People are getting insurance, but there are still obstacles to getting the right treatment and care at the right time," said Jessica Honke, policy and advocacy director for the National Alliance on Mental Illness Maryland, who fielded the call.

Officials with the Maryland Health Benefit Exchange declined to comment on the survey, as did CareFirst BlueCross BlueShield, the dominant carrier on the state exchange. United HealthCare, another insurer on the exchange, said it had not seen the study.

The survey looked at mid-tier level, or silver plans, sold on the state exchange. Insurers pay about 70 percent of costs under these plans, while the policy holders cover the rest. The survey compared those plans to what people on a typical employer-sponsored plan might pay for drugs.

The problem is particularly troubling for patients who have chronic conditions, such as diabetes or high cholesterol, which require medicine to control.

The survey found that on average patients with one or more chronic conditions would pay 66 percent more for medicine than if they were on an employer's plan. The exchange plans have higher deductibles and higher cost-sharing once the deductibles are met.

People with one chronic condition would pay the biggest increase — 89 percent. The medicine to treat diseases such as hypertension, cancer and asthma, and pulmonary and kidney disease would be double or more in relative cost.

The sickest Maryland patients, with four or more chronic conditions, would pay the most for medicine, $1,391, compared with $972 under an employer-based plan.

There also are not enough doctors available in the insurance networks, the survey found.

The survey results were released a day after the Mental Health Association of Maryland released a study that found there aren't enough psychiatrists available on plans sold on the state exchange. Only 14 percent of 1,154 listed psychiatrists were accepting new patients and available for an appointment within 45 days.

People who can't afford their medicine may not take it all or cut pills in half, said Gerald Anderson, a professor at the Center for Hospital Finance and Management at the Johns Hopkins University, who reviewed the study. They may become sicker and wind up in the hospital or emergency room, which would cost more than managing the disease with drugs, he said.

The survey's researchers said access to doctors needs to be improved and plans should be more affordable. The higher costs inadvertently discriminate against people with chronic sicknesses, they said. They believe this effectively negates the provision of health care reform that makes denial of coverage because of chronic conditions illegal.

Researchers said they are working with state Sen. Catherine Pugh of Baltimore and Del. Ariana B. Kelly of Montgomery County, to introduce legislation to address some of the problems. They also said the exchange itself could be improved. For instance, they said, the website could be made more user-friendly so consumers can better compare costs when they enroll.

Peter Beilenson, founder and CEO of Evergreen Health Cooperative, another carrier selling plans on the exchange, said he hasn't heard complaints about the affordability of its plans. But he said improvements to the exchange could help consumers make better choices.

"The exchange is vastly better than last year, but it could still do a better job of comparing the specific costs of different health care plans, including prescription drugs, office visits and hospital visits," Beilenson said.

MedChi, the state's medical society, also released a survey Tuesday that found most Marylanders still support health care reform. The group said they want to work with the state to make it better for consumers.

"Everyone wants this to work," said Gene Ransom, MedChi's CEO. "We need to fulfill the promise of the insurance card."

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