What did the affordable care act (ACA) accomplish when it included prescriptions in its health benefits? A lot. Working to close the gap from the “donut hole,” was one, as well as requiring health insurance plans to cover outlined prescription benefits in order to be an ACA certified plan and participate in the Health Insurance Marketplace.
As the benefits continue to roll out to Medicare beneficiaries and others, the impact on pharmacies has been noted. Here are a list of those impacts:
- The ACA changes prescription costs in that it requires insurance plans (to be ACA eligible) to cover at least one drug in each category and class in the U.S. Pharmacopeia, which is the go-to list of approved medicines.
- Patients and Physicians can request and get access to drugs that are not covered in situations that necessitate an alternative drug be used if the drug needed is not covered.
- Plans keep their own preferred drug lists, also known as formularies. Depending on which plan is chosen, the cost for the same drug can vary.
- Cost for out-of-pocket drugs also vary depending on which level of insurance coverage the consumer has.
- Prescription drug costs are counted towards out-of-pocket caps on medical expenses, which are an estimated $6,400 for individuals and $12,800 for families.
Here are some key numbers about how the ACA has impacted those who benefit from Medicare and Medicaid:
- More than 7.3 million Americans have saved $8.9 billion on prescription drugs
- That translates into $1,209 per person on average!
- The average Medicare-covered patient will save $5,000 from 2010-2022
- Those with high prescription drug costs will save as much as $18,000
The ACA has had a number of positive benefits. What impact has the ACA had on you as you navigate changes in the industry?
