#TBT: Enrollment Deadline & the Role of Rx in Health Exchanges

As part of our “Throwback Thursday” blog series, we’re taking a look at a research topic that’s currently in the news and tagging it with previous research, videos or commentaries in a relevant way. As the saying goes, “what’s old is new again” – and we hope you enjoy our wonky twist on #TBT.

An end to the open enrollment period for the health insurance exchanges is quickly approaching, and the federal government and insurers are making their final pushes to encourage individuals to sign up for coverage. While the health coverage offered via the exchanges will benefit many Americans, there are many patients who remain concerned that they might not have access to the specific treatments they need.

That’s because under the essential health benefits rule, state health insurance exchanges are required to cover at least one prescription drug in each formulary class or as many medications as are covered in the state’s benchmark plan. According to the final essential health benefits rule released by the Department of Health and Human Services (HHS), states must choose the option that offers greater coverage.

During a video interview last spring (and our #TBT pick for this week), NPC Chief Science Officer Dr. Robert Dubois outlined “what to watch for” in the design of the exchanges, especially when it comes to the level of choice that doctors and patients will have in the selection of medications. “For a lot of diseases, only one drug isn’t enough, and there needs to be choices,” Dr. Dubois said. This is particularly true of individuals facing multiple chronic conditions or unique health challenges—often the “average” treatment for their condition is not the one that works best for them. 

Dr. Dubois also pointed out that the amount of out-of-pocket spending patients might have to pay under exchange plans could limit their access to medications. He said if the cost is too high, patients might decide to forgo their medications or skip doses, which could be detrimental to their health if the medicine is keeping a disease (e.g., blood pressure, high cholesterol) under control.

 

Interested in learning more about these issues? Dr. Dubois will lead a session, “How Pharma and Medical Device Companies Will Participate in Health Insurance Exchanges,” at the Second National Health Insurance Exchange Summit on May 15, 2014 at 2:15 pm in Washington, D.C. The summit focuses on public and private health insurance exchanges and responsive strategies by government, plans and providers.