A new paper in JAMA Network Open finds that physicians are bad at figuring out patients’ out-of-pocket prescription drug costs, even when deductible, coinsurance, copay and out-of-pocket cap information is at their fingertips. Of course, the goal of giving physicians this information is to help ensure that cost is not a barrier to patients filling their prescriptions. So, what if physicians can’t calculate patients’ out-of-pocket costs?
The authors tested a hypothetical scenario with a group of physicians. In the scenario, a patient was prescribed a drug that cost $1,000 a month. Physicians were then asked what the drug would cost the insured patient at different times of the year–before the deductible was met, once it was met and a copay (a fixed out-of-pocket amount) was required, once it was met and coinsurance (a percentage of the drug’s cost) was required, and once the patient had reached the out-of-pocket cap.
The authors found that fewer than two-thirds of respondent physicians answered a single one of these questions correctly. Only slightly more than one in five of them (21 percent) answered all four questions about patient drug costs correctly. Bottom line: Calculating patient costs is not easy, even for people with graduate degrees!
The authors conclude that out-of-pocket costs should be simpler to calculate. If physicians can’t calculate them, how can anyone expect patients to do so? The sad truth is that policymakers do not seem to care or to be willing to fix this problem. And, the only solution that will ensure everyone can fill their prescriptions is to have no copayment for life-saving drugs and no more than nominal copayments for all other drugs.
Keep in mind that out-of-pocket costs are just one of many considerations when choosing a health plan. And, because there are so many tradeoffs involved and so many unknowns, it’s not possible to ensure people choose a health plan that meets their needs. At best, you can know whether your doctors are in-network at the time you enroll (doctors can leave at any time,) along with your out-of-pocket maximum. But, whether the health plan will delay or deny access to care your doctor recommends is critically important, yet unknowable.
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