State Efforts to Lower Consumer Cost-Sharing for High-Cost Prescription Drugs

Research Report

State Efforts to Lower Consumer Cost-Sharing for High-Cost Prescription Drugs

September 6, 2017

Abstract

While lowering the cost of prescription drugs has broad support across the political spectrum, there has been little change in federal policy on drug pricing and costs. In the meantime, several states have taken the lead to lower out-of-pocket costs for consumers with chronic diseases needing expensive prescription drugs or specialty drugs. In this brief, the authors provide their findings from a 50-state survey of action on such policies. Eight states have policies protecting their consumers from high out-of-pocket costs for expensive specialty medication. These states either place limits on out-of-pocket spending or require certain plan formulary designs. In supplementary stakeholder interviews the authors found that state policymakers believe the new standards are meeting the twin goals of reducing financial barriers to expensive prescriptions and prohibiting benefit design discrimination against high-cost enrollees. However, the effect of these policies on premium costs and health outcomes is unclear.

Research Area: 

Centers

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