A recently published study in the New England Journal of Medicine found that capping out-of-pocket costs for specialty drugs resulted in a 32% reduction in spending among patients with the highest bills. The reduction in spending occurred without a concomitant increase in health plan spending. The research team found that among patients with out-of-pocket costs in the 95th percentile, the caps reduced out-of-spending costs by $351 per person per month (from $1,109 down to $758) in the three states that imposed them (Maryland, Louisiana, and Delaware).
In the discussion section of the article, lead author Kai Yeing states, “Since a primary function of insurance is to spread the financial risk of catastrophically high spending for a small population, we interpret the caps as strengthening this risk-spreading function without detectably increasing spending for the broader population.”
Read more here.
(Source: Yeung K, N Engl J Med 2020; 383:558-566)