The Affordable Care Act Isn’t So Affordable for the Chronically Ill
23rd February 2015
Human growth hormone is a specialty drug, a category of pharmaceuticals that includes medications for cancer, rheumatoid arthritis, hemophilia and HIV. As the name would suggest, specialty drugs aren’t cheap. There are no generic alternatives.
As such, insurance companies treat specialty drugs differently. Instead of having a flat co-payment, consumers pay co-insurance, which is a percentage of the price the insurer has negotiated with the drug’s manufacturer. Our co-insurance is 30 percent.
So specialty drugs have always been expensive, and co-insurance is not new. But the Patient Protection and Affordable Care Act turned a cost problem into a bona fide cost crisis – pricing middle-class families out of an already heavily regulated market, sometimes forcing people to seek alternatives in Canada or Mexico, and leaving many patients to suffer.
Obamacare’s critics – many on the left as well as the right – weren’t wrong when they complained that the law would be a gift to insurance companies. Although the law capped out-of-pocket medical expenses, specialty drugs were exempt. But that only perverted an already distorted marketplace, encouraging insurers to raise consumer costs while narrowing their choices.