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.
President Trump has repeatedly vowed to reduce drug prices and to lower out-of-pocket drug costs. But for some consumers, the latest proposal could have the opposite effect.
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.
Moreover, it said, “coupons can add significant long-term costs to the health care system that may outweigh the short-term benefits.”
“That increases the likelihood that people won’t pick up their drugs, won’t take their drugs,” Mr. Schmid said.
The changes would result from a new method of calculating inflation in health insurance prices — a factor used in computing the amount of premium subsidies and the annual limit on consumers’ out-of-pocket costs.
The Trump administration estimated that the changes would save the government $900 million annually in subsidies in 2020 and 2021 and $1 billion a year in 2022 and 2023. In addition, it predicted that 100,000 fewer people would have coverage through the insurance exchanges created under the Affordable Care Act.
The administration estimated that premiums — after subsidies, in the form of tax credits — would be 1 percent higher as a result of its proposal.
The limit on out-of-pocket costs is already high; a consumer can be required to spend as much as $7,900 a year. Under the formula now in use, the limit would rise to $8,000 next year. Under the Trump administration proposal, it would increase to $8,200.
The administration said it was concerned that some people who wanted to buy insurance under the Affordable Care act refrained from doing so because they had religious or moral objections to abortion coverage. The administration acknowledged that some states like California, New York and Oregon generally required insurers to offer abortion coverage on the exchange, and it appears that the proposed federal requirement would not override such state laws.
