The American Cancer Society Cancer Action Network (ACS CAN) recently released a report that found that Obamacare plans are not clear enough on their drug coverage and cost-sharing requirements to meet the needs of cancer patients.
The ACS CAN conducted the analysis by examining prescription drug formularies for all silver plans in six states: California, Florida, Illinois, North Carolina, Texas and Washington.
"Taken together, these six states accounted for 46 percent of all marketplace enrollees as of June 30, 2015,” Kirsten Sloan, ACS CAN's senior director of policy, told Patient Daily. “We chose these states for geographic diversity, overall size and number of expected cancer diagnoses in 2015, as well as to achieve a mix of state-based and federally facilitated marketplaces.”
Sloan went on to describe the manner in which transparency was assessed.
“Transparency of prescription drug coverage was assessed by the ease of access to the formulary, including the number of clicks from the marketplace-provided link to the formulary, whether the cost-sharing tiers listed on the formulary matched the cost-sharing structure presented on the marketplace, whether formularies were searchable and whether they included any out-of-pocket cost estimates,” she said.
In particular, Sloan said, ACS CAN found issues with limitations in coverage of newer oral chemotherapy medications; a lack of clarity for intravenous medication coverage; cost-sharing structures presented in plan formularies did not match those presented on marketplace websites; and plans continue to place most or all oral chemotherapy medications (generic included) on the highest cost-sharing tier, presenting cost barriers and a lack of transparency for patients.
Sloan said it is critical that Obamacare plans are transparent for patients suffering from cancer.
“Transparency is a critical issue for both people in active cancer treatment as well as survivors, so that they can find the insurance plan that best meets their needs,” she said. “Barriers to accurate information can present long-term cost and coverage implications. If cancer patients are making health coverage selections based on incomplete or inaccurate information, they may end up with unexpected out-of-pocket costs that could force them to delay or -- worse -- forego lifesaving treatment.”
