Insurers Lower Cost of Preventative Drugs

Major health insurers Aetna, WellPoint, and Humana have discovered that reducing patient cost-sharing for preventative drugs can increase patient compliance with drug therapies, improve outcomes and cut the total cost of care.  

healthcarereformmagazine.com

Improving medication compliance is increasingly important as the country's elderly population increases and more Americans are living with chronic conditions.  As baby-boomers become Medicare-eligible, 157 million Americans will have at least one chronic condition such as heart disease, cancer, hypertension, stroke and diabetes, according to the Centers of Disease Control and Prevention, by 2020. 

"Some payers have reduced cost-sharing—including waiving deductibles and reducing or eliminating copayments and coinsurance—for drugs used for primary prevention, such as statins prescribed for patients with high blood cholesterol and lipids who have never had a heart attack. Others such as Aetna have gone further and reduced or waived cost-sharing for drugs used for secondary prevention, such as statins, for patients who already have had a heart attack to reduce the chance of a recurrence.  Other medications for which some insurers have reduced or waived cost-sharing include drugs for preventing or treating high blood pressure, asthma, stroke, diabetes, osteoporosis, pediatric conditions, and maternal and fetal problems." (ModernHealthCare.com.) 

These cuts to patient costs for preventative care can be attributed, in part, to the Affordable Care Act's "first-dollar" coverage requirement for preventative services.  If the ACA requires that a preventative service be provided "first-dollar," this means that there cannot be any cost-sharing.  In other words, the preventative service or drug is free for the patient. This is true for services and drugs from both in-network and out-of-network providers and pharmacies.

This change is also related to the growth of consumer health plans with high deductibles.  Insurers have realized that providing preventative services and drugs below the deductible raises the quality of care a patient receives while lowering prices.