Exchange Plans Pose More Prescription-Use Barriers

Patients covered by exchange-based insurance are more likely than those in employer-sponsored plans to face utilization management controls—such as prior authorization and step therapy—in filling their prescriptions, a report Monday from healthcare consultancy Avalere Health contends.

In the mental health category, 50% of drugs were covered without utilization management in employer-sponsored plans versus 15% in exchange-based plans, according to Avalere's data. Also, 27% of oncology drugs were covered without utilization management in employer-sponsored plans, compared with 16% in exchange-based plans. The majority of HIV/AIDS drugs—60%—were covered free of utilization management in exchange-based plans, but that number still paled in comparison to patients with employer-sponsored insurance.

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Source: Modern Healthcare