New coverage features such as Hixme’s Copay Cap™ can arm you against this insatiable monster
Soaring prescription drug prices shock but do not surprise us. How have we come to this? And what can you do about it?
How bad is it?
According to the GoodRx Blog:
- The cash price for the average brand-name prescription drug has increased 48% since 2013 – however, these brand name drugs actually treat relatively few people.
- Less dramatic, so garnering much less attention is the fact that 85% of prescriptions are typically generic, not brand name. These more affordable drugs treat common chronic conditions such as high blood pressure, high cholesterol, chronic pain, diabetes, and depression.
- More than 3 billion prescriptions are written for generics every year.
- More than 50% of Americans are at risk of paying the full cash price for generic medications due to the ACA and high-deductible plans that require deductibles be paid before an affordable copay kicks in.
The sunny side: On average, generic drugs are getting cheaper. Patents on many popular drugs – Crestor, Abilify, Nexium – have expired in recent years, and many high use drug categories are available as generics – like statins or anti-depressants.
Hixme’s Copay Cap™ is an additional cost saving feature of the Hixme Health Bundle™ that limits your out-of-pocket expenses for in-network primary/specialist doctor visits and prescriptions.
Also – most people assume their plan co-pay for a generic drug is the best (or only) deal they can get. But surprisingly, many times it’s not. Often, it’s cheaper to pay in cash for a prescription than to go through insurance, points out Gwendolyn Klein, co-founder and owner of Values Based Patient Advocates in Chantilly, Virginia. But this requires patients to be much more active consumers.
Similarly, many employer health plans have stand-alone savings vehicles such as Flexible Savings Accounts (FSA’s), or Health Savings Accounts (HSA’s) that make these kinds of “negotiating” opportunities even greater personal value opportunities for a patient.
And finally, a new generation of hybrid plans that link health coverages with newer forms of cash reimbursements, such as the Hixme Health Bundle™, empower consumers even more. Under these kinds of programs, patients with sizable prescription balances can receive reimbursements to normalize their out-of-pocket exposure to a plan committed level regardless of health plan coverage anomalies.
Why is this such an issue now? In the past, many policies routinely covered the cost of common generics. With an average co-pay of about $10 most consumers didn’t know the actual cost of their medications. Unfortunately, in the past decade, that reasonable $10 copay has eroded, and consumers experience extreme variations in prices, if they find a way to even compare!
The Affordable Care Act (ACA) includes medications as an Essential Health Benefit in all coverages. But like most regulations, there are side effects that result from market adjustments to control overall price. Routinely now, carriers have:
- Defined more tightly limited formularies (the lists of drugs covered by insurers)
- Increased requirements for prior authorizations
- Included higher deductibles – as high as $6,500 a year for the least expensive plans – before medication coverages and related co-pays apply
- Categorized medications into increasingly complicated cost tiers, sometimes as many as six.
- Replaced fixed copays with “coinsurance” (a percentage of the total cost) making it difficult for a patient to know what their share is until actually filling a prescription.
“All this means that the average American has been quickly exposed to what’s called “usual and customary” (U&C) prices, which are the staggeringly high list prices for prescriptions that were never really intended for consumers to actually pay,” says Doug Hirsh, author of the Good Rx blog.
New companies such as Good Rx are part of a growing movement of companies offering comparison charts and discounts to counter this trend. Hixme has another approach that can be helpful for larger employers and their workers.
Hixme’s solution: The Copay Cap™
One of the elements of our revolutionary approach is our Copay Cap that is part of our Hixme Health Bundle™. The Copay Cap is an additional cost saving feature of the Bundle that limits your out-of-pocket expenses for in-network primary/specialist doctor visits and prescriptions. If your share of the cost is more than Hixme’s Copay Cap, you can be reimbursed for the difference.
Below is an example for three Hixme Bundle Categories (Flexible, Balanced and Secure)
This is just one of the many ways we address giving large employers and their workforce of smart consumers greater ownership, affordability and choice in their health coverage.
To find out more about the Hixme solution for your company and its workers, contact us today.
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ABOUT THE HIXME THINK BLOG: This post is authored by Hixme’s VP of Client Services Tammy Olson. Postings reflect market trends and the powerful emerging movements toward true portability and personal ownership by workers and their families. Postings follow these emerging trends, driven by consumer ownership of retirement benefits, consolidations by health care institutions, and the stated pro-consumerism goals and actions of the administration, federal agencies and Congress.