Benefits designers may be intentionally luring insurance buyers into health insurance plans with high drug costs by keeping premiums artificially low.
A study of exchange marketplace health plans by Avalere Health found that most of the plans examined pushed all drugs used to treat complex diseases into the drug formulary with the highest cost-sharing tier. Avalere said the plan's premiums appeared to be kept low, with plan designers apparently expecting higher revenue from the drug cost-sharing to offset the low premiums.
"Plans continue to innovate on benefit design in the exchange markets," said Avalere CEO Dan Mendelson. "These designs are calibrated to optimize enrollment by delivering low and stable premiums — the primary metric that consumers use to select a plan."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
