Study Evaluates Benefits of Cap on Prescription Drug Cost-Sharing for Patients on Exchanges

Commissioned by The Leukemia and Lymphoma Society, the results of the study help make the case for placing limits on out-of-pocket costs for patients that would relieve their financial burden without a significant impact to insurers.

A new study finds that capping the cost-sharing for prescription drugs on individual policies in the health insurance marketplace would reduce patients' annual out-of-pocket healthcare spending, and have a small effect on insurance premiums while allowing insurers to remain compliant with the law.

This new study, which The Leukemia & Lymphoma Society (LLS) commissioned from Milliman, Inc, examines the impact of imposing dollar limits on out-of-pocket costs for patients who purchase their insurance through health exchanges established under the Affordable Care Act (ACA). The study measures how these dollar limits would reduce patients' out-of-pocket costs, the implication for insurers that must meet Actuarial Value Calculator requirements, and the impact on premiums for these plans. The study finds that the majority of benefit plan options examined can be accommodated with either no adjustments to other benefit features or with minor adjustments.

Link to the press release by PRNewswire:

Link to the published report: