More than 40 percent of Americans have high-deductible health plans, which frequently require them to pay significant out-of-pocket costs for health care. These higher out-of-pocket costs are often the cause of financial stress, poor disease control, increases in hospitalizations and exacerbation of health disparities. But what if a person with a chronic condition could obtain his or her medicines or care without having to pay those out-of-pocket costs or meet a $1,300 or higher deductible first?
According to a new issue brief from VBID Health, providing pre-deductible coverage for medicines used to treat common chronic conditions could lower out-of-pocket costs and increase medication adherence for patients. For patients, access to affordable clinician visits, diagnostic testing and prescription medications are critical components of disease management.
Under current law, however, only certain types of preventive services may be covered by a health care plan prior to meeting the plan deductible. Until the deductible is met, “coverage does not include ‘any service or benefit intended to treat an existing illness, injury or condition, including drugs or medications.’” While preventive care is important, chronic conditions cannot be overlooked: Spending on chronic disease comprises a substantial majority of total U.S. health care expenditures.
The VBID Health paper considers the financial impact of pre-deductible coverage of medications for chronic conditions should the current law be changed. Although it would increase utilization and shift some costs to health care plans, overall impact would be modest, requiring a premium increase of less than 2 percent.
Above all, the benefit of this change is greatest for patients and consumers with chronic conditions. Reducing non-adherence, improving patient outcomes and lowering health care costs could make a difference in the lives of millions of Americans.
The paper was funded by the National Pharmaceutical Council, a health care policy research organization based in Washington, D.C.