Issues on coverage: Steep Rx costs; federal plan eliminates 'transgender exclusion'

Oct 14 2014

Even patients with insurance are finding that specialty drugs can quickly eat a hole in their wallets because insurers are often putting them in a special tier and demanding high consumer co-payments. Also, the State Department is getting rid of the "transgender exclusion" in it largest health plan, and some consumer advocates are suggesting that people getting coverage on the health marketplaces be allowed to get "wrap-around" plans through their employers.

Kaiser Health News: Got Insurance? You Still May Pay A Steep Price For Prescriptions
Even with insurance, some patients are struggling to pay for prescription drugs for conditions such as cancer, arthritis, multiple sclerosis or HIV/AIDS, as insurers and employers shift more of the cost of high-priced pharmaceuticals to the patients who take them. Increasingly, health plans – even those offered to people with job-based coverage--require hefty payments by patients .... In some plans, patients must pay 20 to 40 percent or more of the total cost of medications that insurers deem to be specialty drugs and place in the highest tiers of patient cost sharing (Appleby, 10/13).

The Washington Post: State Allows Employee Health Insurance To Cover Transgender Services
The State Department, which has been on the leading edge of policies affecting lesbian, gay, bisexual and transgender federal employees, is eliminating the "transgender exclusion" from the agency's largest health insurance program. Insurance policies under the Federal Employees Health Benefits (FEHB) program generally exclude services "related to sex reassignment" (Davidson, 10/12).

Richmond Times-Dispatch: Businesses Should Check With Insurance Carriers On Putting Same-Sex Spouses On Health Care Policies
When the U.S. Supreme Court cleared the way Monday for same-sex marriage in Virginia and four other states, couples began getting married that day. Now, same-sex couples are also eligible for the same types of employer-provided benefits as other married couples (Bacque, 10/11).

Politico Pro: As Employers Cut Health Plans, ACA 'Wraparound' Coverage Iffy
Wal-Mart's announcement that it will end health benefits for employees working fewer than 30 hours weekly may shape discussions on whether workers who get insurance on the Obamacare exchanges can supplement that with some employer-sponsored coverage -; an option several of the country's biggest unions support. The AFL-CIO, United Food and Commercial Workers International Union and others have pressed the Labor Department for much of this year to allow part-time workers on ACA plans to still obtain limited employer benefits that they would then "wrap around" their Obamacare coverage. These benefits could include broader provider networks or help to lower out-of-pocket costs, to name two (Pradhan, 10/10).