States eye health insurance regulations to control drug costs | FierceHealthcare

Read the following. How does all that sound to you, good ideas? My favorite is the requirement that only fixed co-payment drug plans can be offered. What nonsense?

How in any world does this control drug costs? Rather than control costs such measures may well increase them … at least for taxpayers and others actually footing the bill. In addition, further insulating patients from the real costs only encourages over utilization and misuse.

img_0163This is a typical example of the political/bureaucratic mindset that gets us into trouble over and over. The goal should not be to ease consumer cost burdens, but to address the basic cost issue regardless of who is paying. This is the mindset that allows people to claim that Obamacare made health care “affordable.”

Can’t say they aren’t honest about their shortsighted stupidity though. Maybe the answer is to just endlessly shift costs from here to there. 😳

Healthcare insurance companies are actively fighting to keep drug costs low for their members and for their own bottom lines. Now a new policy brief offers state policymakers tips on how to shift more of the costs to payers in an effort to protect consumers.g

The brief (.pdf) from the National Association of Insurance Commissioners outlines several regulations policymakers can adopt to ease consumers’ cost burdens, including:

Imposing restrictions on how many cost-sharing tiers per plan insurers can use, as in the case of standardized plans in New York, Vermont and Massachusetts, where ACA plans are limited to three tiers. Policymakers should also prohibit payers from switching a drug they cover to a costlier tier over the course of the plan year.

Locking health plans into their list of covered drugs, rather than giving them the option to change them midway through the year. Such changes are already prohibited in most cases in Texas and Nevada, but an Avalere analysis in all 50 states and the District of Columbia found nearly half of plans made changes between October 2013 and September 2014. Plans should be given flexibility for mid-year changes that add to the lists, however. “These formulary changes have the potential to enhance consumer coverage, rather than detract from it, and should be allowed at any time,” the report states

Prohibiting plans from charging a percentage-based coinsurance rather than a flat dollar copay. Montana law, for example, requires payers to offer a single silver-level marketplace plan that only charges copayments for drugs.

“States have long played this role, trying to make policies that work for consumers,” co-author Katie Keith told Kaiser Health News.  “It’s more urgent now with all the crazy drug prices we’re seeing.”

Source: States eye health insurance regulations to control drug costs | FierceHealthcare


2 replies »

  1. #Imfromgobment_I’mheretohepyou Aetna and UnitedHealth are pulling out of Obamacare in many states and counties because they’re losing money. Meanwhile, the Obama Administration is blocking Aetna from merging with Humana, and sued to stop Anthem from buying Cigna (maybe its vice versa).  Insurance companies are trying to remain in business by pulling out where they are losing money, and merging with other companies to spread risk and lower overhead. The Obama Administration is actively preventing merging . If I were conspiracy minded, I’d think the Left in charge wants insurance companies to fail, thereby allowing the government to step in.    


  2. Endlessly shift is the goal, so every time you complete a full circuit, as a legislator, I get to use the same stuff to buy more votes.

    In terms of copayment a, no problem. Obviously, you have point of purchase and point of enrollment cost sharing. So, after your comprehensive deductible of $5,000, copay’s work well – and the rest lands in the premium. Say, a copay of $300 or 100% of the cost, if less. Works for payouts, works for me.

    Remember, there are at least 50 stupid state insurance commissioners who share stupid stuff like this and think they will be able to combat market forces.


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