Cost-Sharing and Drug-Price Transparency in New York

Both State and federal policymakers have voiced concerns regarding the rising cost of prescription drugs and price transparency in health care.

In New York, prescription drug cost-sharing is defined by State law for most markets for health insurance, with the exception of federally regulated employer-sponsored or Medicare plans. However, many New Yorkers are unaware about the price of prescription drugs.

A new report by the Manhattan Institute, supported by NYHealth, highlights some aspects of the prescription drug market that prevent price transparency tools for consumers from being efficient. The findings suggest that if insurers have more flexibility in designing cost-sharing and price transparency tools, consumers will have improved access to this information and can make better decisions in their health care. Key findings are:

• The high prices of prescription drugs are the result of monopolies established through patent systems that shield drugs from competition.
• The prescription drug market also does not allow for shopping around by consumers in the same way as choosing hospitals or physicians.
• Individuals pay different amounts for the same drugs depending on their insurance plan, and many of the uninsured are eligible for patient assistance discounts from manufacturers. As a result, public disclosure of a singular list price may mislead rather than enlighten policy debates.