There’s one clear disconnect in American healthcare.
Steve Miller, the top doctor at the healthcare company Express Scripts, put it simply.
“High-deductible health plans are designed for wealthy people and sold to poor people,” Miller said Thursday at the Forbes Healthcare Summit in New York.
Miller’s remarks came during a discussion about the high costs patients often pay for vital prescription medicines in the US. With high-deductible plans, they can be required to pay thousands of dollars for medical care and prescriptions before their health insurance kicks in.
The plans can be appealing to people with high incomes because they’re often paired with a savings account that lets them put aside money to pay for health expenses without paying taxes on it. But people with lower incomes often end up buying high-deductible plans, because they’re typically less expensive.
The plans are becoming increasingly common. This year, nearly half of Americans under 65 with private health insurance had high-deductible plans, up from about 25% in 2010. Those plans require a person to spend at least $1,350 — or at least $2,700 for family plans — before their health insurance starts covering their care.
Some health plans, though, can have deductibles that exceed $10,000.
High-deductible plans and other methods of shifting costs to patients are a key reason patients face high drug prices at the pharmacy counter. That’s an important issue for Express Scripts, a company that negotiates prescription-drug prices with pharmaceutical companies, also known as a pharmacy benefit manager.
The healthcare blame game
The US system for paying for prescription drugs is complicated. Patients with high-deductible insurance plans often don’t pay the lower prices negotiated by companies like Express Scripts until after they’ve met their deductibles.
Instead, they have to pay the higher list prices set by drugmakers. That has contributed to finger-pointing among pharmacy benefit managers, drug companies, and health insurers over who’s really at fault for the high prices that consumers are facing.
“We have got to fix the insurance market, because we cannot have people being exposed to some of these high-deductible plans when they clearly can’t do it,” said Miller, Express Scripts’ chief medical officer.
That remark is notable because Express Scripts will most likely soon be part of a health insurer. Cigna agreed to acquire it in a $67 billion deal earlier this year, though the transaction hasn’t been completed.
The biggest pharmacy benefit manager, CVS Health, is also joining forces with a health insurer. Its $70 billion acquisition of Aetna was completed on Wednesday.
In an interview on the sidelines of the Forbes event, CVS Health’s CEO, Larry Merlo, said his company might look into changing the design of Aetna’s health plans to take into account concerns about high-deductible plans. He didn’t go into detail.
Merlo said his company was also trying to help eliminate sticker shock — when patients show up at the pharmacy counter and face unexpectedly high costs for their drugs.
CVS is rolling out a service to 100,000 doctors offices by the end of 2018 that allows doctors to see how much their patients can expect to pay at the pharmacy counter for drugs they’ve prescribed. The system also suggests alternatives. Merlo said that so far, doctors have switched to other medications 40% of the time, saving patients on average of $125.
“To us it’s an important data point that physicians are recognizing that out-of-pocket costs are now a variable in terms of the quality of care that they can provide,” Merlo said. “We think there’s a lot more that we can do around that.”