Delay in Obamacare limits may lead to more insured being self-pay when it comes to prescription drugs

The news yesterday that limits on out-of-pocket expenses for the insured under Obamacare will be delayed until 2014 may leave more people in the same boat as the uninsured when it comes to buying prescription drugs. As the New York Times reports:

A limit on consumer costs is delayed in health care law

…the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.

The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014… 

Under the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.

Some consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.

While it’s hard to predict exactly how this will play out, it does look like many of the insured are going to find themselves facing bigger health care expenses than they might have expected in 2014, and will be self-pay patients for at least their prescription medicines.

Fortunately, self-pay patients have several options for keeping their pharmacy bills in check. I mentioned in a previous post that that one friend of mine is able to reduce his spending on prescription drugs  by shopping online at BidRx. You can also shop for the lowest prices offered by local pharmacies at online services like and WeRx, both of which offer mobile apps for your phone as well.

And don’t forget generic pharmaceuticals! While there can be differences between name-brand drugs and generics that make them less effective for some, the savings for patients that can use generic drugs can be substantial. Several ‘big box’ pharmacies offer hundreds of commonly prescribed generic medicines for only $4 for a 30-day supply, including Walmart and Costco.

There are other options as well, which I plan to describe in future blog posts. But as you can see, being a self-pay patient when it comes to prescription drugs, just like other medical services, doesn’t have to mean taking a big hit financially.

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4 Responses to Delay in Obamacare limits may lead to more insured being self-pay when it comes to prescription drugs

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