![]() ![]() Standardized Benefit Plan Design: The Affordable Care Act (ACA) created health insurance marketplaces through which individuals may purchase health insurance that meets the standards of quality coverage under the ACA.Prescription Drug Cost Caps: States may cap the amount that a patient pays per month per drug or create a fixed copay option that is a flat amount that applies to all prescription drugs.Deductible Protections: States can help protect patients by ensuring there is no deductible to meet for prescription drug costs or by having a limited separate prescription drug deductible.NORD evaluated state out-of-pocket patient protections on the following: Explaining the Prescription Drug Provisions in the Inflation Reduction Act. Public Opinion on Prescription Drugs and Their Prices. Hamel, L., Lopes, L., Kirzinger, A., Sparks, G., Kearney, A., Stokes, M., & Brodie, M.“Prices Drove Spending Growth: Trends In Employer-Sponsored Insurance Costs, 2014-2018”, Health Affairs Blog. Brennan, N., Fuglesten Biniek, J., & Hargraves, J.Marketplace Pulse: Cost-Sharing in the Marketplace, 2021. ![]() 5įor the purposes of this report, the analysis of out-of-pocket cost protections focuses solely on state-regulated health insurance plans. Additionally, in August 2022, President Biden signed into law the Inflation Reduction Act, which will limit the out-of-pocket prescription drug costs for Medicare Part D beneficiaries to $2000 annually, but that will not begin until 2025 and is only applicable to Medicare beneficiaries who participate in the Part D program. It is important to note that state lawmakers do not have authority over all forms of health insurance. In recent years, there has been a push in state legislatures to assist patients with increasingly high prescription drug out-of-pocket costs, and states have explored different types of legislation with varying impacts on patients’ out-of-pocket spending. Of those who were unable to afford their drugs, three in ten say they have not taken their medicine as prescribed due to cost. For example, according to the Kaiser Family Foundation, 26% of all adults report difficulty affording their prescription drugs. ![]() Exorbitant out-of-pocket costs can force patients to go without their medication or to use alternative treatments that are not as safe and effective. 3 These actions can have grave consequences.
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