Comparing Out-of-pocket Expenses In European Health Insurance Plans

Comparing Out-of-pocket Expenses In European Health Insurance Plans – Joseph Burns ( @jburns18 ), a freelance journalist based in Brewster, Massachusetts, is AHCJ’s topic leader on health care reform. He welcomes questions and suggestions and tip sheets at joseph@.

Last fall, the U.S. House of Representatives narrowly passed a $2.2 billion domestic spending plan called Get Back Better (BBB) ​​that included several health care provisions, including one that would limit what diabetes patients pay for insulin at $35 a month. A month later, Sen. Joe Manchin (D-West Virginia) effectively killed the bill when he announced that he could not support the bill.

Comparing Out-of-pocket Expenses In European Health Insurance Plans

Source: Comparing Insulin Prices in the US and Other Countries, prepared for the Office of the Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services by RAND Health Care. September 2020

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Efforts to limit how much patients pay for insulin, however, are still being debated in Congress; some laws could be passed in the coming weeks. If so, health journalists will need to know how any new law would work. One helpful resource may be last week’s report from the Peterson Center for Health Care and the Kaiser Family Foundation (KFF), “Out-of-Pocket Spending on Insulin Among Individuals with Private Insurance.”

For healthcare journalists, there are at least three important things to understand about efforts to limit what diabetes patients pay for their care.

First, putting a cap on out-of-pocket costs is key, but it does more than tinker around the edges of the problem. Patients with diabetes need insulin and supplies to monitor blood sugar and store and inject insulin. In 2020, researchers for the Commonwealth Fund reported that about 30 million Americans have diabetes, and about 31% of them need insulin to treat the condition. Fall prices for many of the newest forms of insulin have risen 15% to 17% each year since 2012, the report said.

Second, it is important to understand that any cap on what patients pay out-of-pocket for insulin would not apply to the base cost of insulin in the US, as explained in the Peterson-KFF report. What diabetes patients pay for insulin in the U.S. is much more than in other countries, according to a report released by the U.S. Department of Health and Human Services (HHS) in 2020. For the report, HHS contracted with RAND Health Care to compare what pharmaceutical companies charged for insulin in the US in 2018 with what pharmaceutical companies charged in 32 other countries that are members of the Organization for Economic Co-operation and Development (OECD).

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RAND researchers found that the average gross producer price of a standard unit of insulin in 2018 was $98.70 in the US, more than 10 times the price of $8.81 per standard unit of insulin in 32 other countries.

US drug manufacturers often claim to give rebates to patients, health plans, employers and pharmaceutical benefit managers. In their report, RAND researchers took rebates into account, showing that US insulin prices were about four times higher than those in other countries.

Third, some reporters who have written about efforts to limit what patients pay for insulin have mistakenly reported that the BBB proposal would cap the cost of insulin. The insulin provisions in the BBB and now in other legislation being considered by Congress would limit only what diabetes patients who have health insurance pay each month for insulin. Health insurers would still pay full price for insulin, as Connecticut health care advocate Ted Doolittle explained on Twitter (@TedDoolittle2) and elsewhere, including in AHCJ’s February webcast, “Reporting Diabetes Care and Costs.”

Peterson-KFF cites legislation in Congress that would limit patients’ out-of-pocket costs of insulin, including the End Expensive Insulin Act, introduced last year by Sen. John Kennedy (R-Louisiana) and the Affordable Insulin Now Act, introduced by Sen. Raphael Warnock (D- Georgia) introduced in February.

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Last week,  Reuters reported  that Senate Majority Leader Chuck Schumer said he intended to hold a vote this spring on a bill that would cap the $35-a-month cost of insulin. Also, Schumer added, the monthly cap would be paired with other plans to reduce the amount patients pay “in a more comprehensive way, including protecting the uninsured,” Reuters reported on Schumer’s comments.

Days later, on March 26, Forbes published a video of Schumer explaining his plan to cap how much patients pay for insulin.

The Peterson-KFF report explains that the Affordable Insulin Now Act and the wording in Build Back Better would require insurers offering Medicare Part D plans and health plans to charge no more than $35 per month for insulin products. Group or individual health plans would have to cover at least one dose of each type of insulin (including premix, rapid-acting, short-acting, intermediate- and ultra-long-acting) when available and limit cost-sharing to no more than $35 for a 30-day supply of each type, the report explained .

A $35 monthly cap on out-of-pocket insulin costs could provide significant savings for diabetes patients who need insulin. More than one in 20 insulin users who have commercial health insurance pay more than $150 a month for insulin, according to the report. For those with health insurance on the individual market, the median savings would be $27 a month, and about 25% would save at least $71, the Peterson-KFF report showed.

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For those with health insurance from small employers, the median savings would be $19 each month, and 25% would save at least $48, the report said. For people with health insurance from larger employers, the median savings would be $19 each month, and 25% would save at least $42. The International Federation of Health Plans’ Price Comparison Report details health care products and services around the world. Its most recent research in 2017 looked at seven countries: the United States, the United Kingdom, Switzerland, Australia, New Zealand, South Africa and Spain.

The results showed that not only were health care costs higher in the US compared to other countries in the survey, but there was also a significant difference in how much people in the US paid for the same drug or medical procedure. In the study, the Federation wanted to prove that it is about unit costs, and not about usage as many think. Prices in the US are on a like-for-like basis higher than their counterparts in other countries.

Tom Sackville,  executive director of the IFHP, said many people mistakenly believe that Americans are spending more time in hospitals, seeing doctors or having procedures, which is what drives up prices. “That’s not the case. It seems to be a pretty effective system — they’re not overusing it,” Sackville said. “But every time they have an item, an episode of care, it costs two or three or five times more than it should, by international standards.”

The U.S. data is drawn from more than 370 million medical claims and more than 170 million pharmacy claims, which the Federation says reflect prices negotiated and paid to health care providers. By comparing procedures in seven countries, the Federation ensured that the whole process was “similar, across international borders”, Sackville said. For example, when comparing the cost of a standard MRI scan, the data came from procedures that used identical types of machines with equal staffing resources per procedure.

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Not only did the Federation conclude that the average price in the US is far higher than anywhere else, but it also found a large disparity in prices paid within the US. Sackville called the significant variation in costs “completely unjustified for any clinical reason”.

For example,  the average cost in the US for an MRI scan was  $1,119, compared to $811 in New Zealand, $215 in Australia and $181 in Spain. However, the data showed that the 95th percentile in the cost of the procedure in the US was $3,031, meaning some people were paying nearly $3,000 more for a standard MRI scan in the US than the average person in Australia and Spain.

Or have a standard hip replacement procedure. The average price in the US is $29,067, which is $10,000 more than the next highest-priced country, Australia. However, the data shows that the 95th percentile cost in the US reaches $57,225,50,000 more than the average cost in South Africa and $42,000 more than in New Zealand. The results for knee replacement are generally the same. Sackville added that the study suggests that more expensive procedures are no better than average or low-cost procedures.

The researchers also noticed a trend in prescription drugs. Avastin, which is prescribed as a treatment for certain types of cancer, has an average price of $3,930 in the US. Switzerland is the second most expensive at $1,752. However, the data shows that the 95th percentile in the US paid up to $8,831. Avastin costs $470 in the UK.

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Similar trends were seen in Truvada (HIV/AIDS drug), Harvoni (hepatitis C), Humira (rheumatoid arthritis) and Xarelto (blood clot prevention). One of them was OxyContin, the most expensive generic pain reliever

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