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Trump proposals could increase health costs for consumers

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Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.

[WASHINGTON] Consumers who use expensive brand-name prescription drugs when cheaper alternatives are available could face higher costs under a new policy being proposed by the Trump administration.

The proposal, to be published this week in the Federal Register, would apply to health insurance plans sold under the Affordable Care Act.

Health plans have annual limits on consumers' out-of-pocket costs. Under the proposal, insurers would not have to cover the full amount of a consumer's copayment for a brand-name drug — only the lower price for a generic version.

For example, if a consumer filled a doctor's prescription for a brand-name drug with a US$25 copayment, rather than using a generic medicine with a US$5 copayment, the consumer might get credit for only $5 in out-of-pocket spending. Consumers would have to spend more of their own money before reaching the annual limit on out-of-pocket costs.

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In addition, insurers would not have to count the value of coupons and other financial assistance provided to consumers by drug manufacturers if generic alternatives were available. This change could significantly increase consumers' out-of-pocket costs for some of the more expensive prescription drugs and has prompted protests from groups representing patients.

The proposal highlights a potential conflict between patients with a particular disease, who may benefit from the use of coupons, and other consumers more generally. Economists say that coupons can raise health care costs by encouraging people to use more expensive drugs.

"The availability of a coupon may cause physicians and beneficiaries to choose an expensive brand-name drug when a less expensive and equally effective generic or other alternative is available," the Trump administration said. "When consumers are relieved of copayment obligations, manufacturers are relieved of a market constraint on drug prices."

Moreover, it said, "coupons can add significant long-term costs to the health care system that may outweigh the short-term benefits."

But Bari Talente, an executive vice president of the National Multiple Sclerosis Society, said, "Many people with MS rely on copay assistance, even for generic medications."

In the last few years, she said, generic versions of the drug Copaxone have become available, but even they have high prices.

NYTIMES