A new report finds that marketplace plans usually cover a large number of antidepressants; however, consumers shopping for a plan may have a difficult time finding out which antidepressant drugs are covered and how much they will have to pay out-of-pocket in order to get them if they enroll in a specific plan. The report, prepared by researchers at the Urban Institute with funding from the Robert Wood Johnson Foundation, analyzes the marketplace and insurer websites of five select states to determine the availability, accessibility, and cost of antidepressant prescription drugs.
After analyzing three state-based marketplaces (California, Maryland, and Minnesota) and two states relying on HealthCare.gov (Alabama and Florida), the report authors find a significant level of variability in marketplace antidepressant coverage. Seventy-four percent of insurers studied exclude anywhere from one to five antidepressants from their formularies (i.e., the list of drugs covered by a health plan); however, some insurers exclude as many as 15.
The report authors also find a lack of transparency when it came to consumers’ ability to find information about limits on coverage, out-of-pocket costs, and processes to appeal for exemptions for drugs not covered by a plan.
Following their findings, the report authors recommend a series of improvements the marketplaces can make to improve consumers’shopping experience, including requiring insurers to provide links to up-to-date, searchable lists of drugs they cover. The authors go on to advise that the marketplaces should build tools that would allow for consumers to search plans based on the coverage and cost of specific drugs. They also note that insurers could make out-of-pocket costs of drugs more transparent for consumers by instituting co-payments for drugs rather than the strategy of co-insurance currently used by many insurers (i.e., consumers paying a percentage of the total cost of a drug rather than a flat fee each time a prescription is filled).
"Many consumers who are shopping for insurance have specific information needs," said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. "While decision support has improved significantly, there is clearly a need to develop more targeted assistance that is focused on particular conditions."
