When it comes to the accessibility of prescription drugs, individuals may be better off by sticking with employee benefits than utilizing a plan that's purchased through the federally facilitated or state-based exchanges, according to the results of new analysis.
Consumers who purchased coverage through the health marketplaces were approximately two times more likely to encounter onerous utilization management issues for medication versus those who paid for coverage through a policy that their workplace provided, reported Avalere Health, an advisory services company.
For example, among those who required mental health or oncology drugs, which treat the formation of tumors, they tended to be more likely to be subject to step therapy or prior authorization. In fact, more than 70 percent of these prescription medications covered by insurance needed some level of utilization management before consumers could gain access to them.
Caroline Pearson, vice president at Avalere, noted that people who are uninsured or are contemplating changing plans should be sure to do all of their homework.
"This is one more reminder that consumers shopping on the exchange need to look beyond premium costs when picking a plan," said Pearson. "Patients may be better off selecting a plan that includes open access for drugs they use regularly, and they will need to work closely with their physicians to fulfill utilization management requirements where they exist."
This latest report may conflict many with one of the reasons why some people are supportive of the Patient Protection and Affordable Care Act. According to a recent separate poll commissioned by the Kaiser Family Foundation, of those who approved of the ACA, more than 6 in 10 said it was mainly because it expanded access to care and insurance.
