Patients who think they have done well finding a relatively low premium in an exchange plan under the Patient Protection and Affordable Care Act may be in for a rude awakening: limited access, and hefty costs, to the important drug coverage they need.
That's the analysis from Avalere Health, which concluded that consumers purchasing insurance through the exchanges are twice as likely to face utilization management controls on prescription medications compared to people with employer-sponsored coverage.
Utilization management controls are administrative steps that patients and their physicians must complete to demonstrate appropriate use of the drugs. These tools are used by health plans to limit access to specific medications and reduce costs.
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