Prescription Drug Costs, Coverage Vary Under MNsure Plans

Updated: 10/01/2013 10:23 AM By: Stephen Tellier

One of the many question marks hanging over MNsure involves prescription drugs, including which ones will be covered and how much they will cost.

According to the Kaiser Family Foundation, Minnesotans spent $3.3 billion on prescription drugs at pharmacies in 2011. Within days, thousands more Minnesotans are going to have drug benefits.

"You have to do a little bit of homework. No one can do this for you because you are different than everybody else," said Michael Showalter, senior vice president of individual markets at Prime Therapeutics, which helps manage pharmacy benefits for insurance companies. "It can be really confusing."

That is putting it mildly. Just one provider's breakdown of benefits, outlining its various MNsure plans, runs more than 100 pages.

Showalter said to watch for varying prescription drug coverage and costs under MNsure.

"These plans will cover different drugs under different conditions," Showalter said.

But we do know this -- all MNsure plans are required to offer some kind of prescription drug coverage, and including those prescription costs, the most patients can pay out-of-pocket each year is about $6,300 for individual health care or $12,700 for a family -- as long as you're in network.

"It does require a little bit of homework, but the average person can make these decisions, and there's no reason not to have coverage," Showalter said.

Showalter also said even if you're not enrolling in a MNsure plan, you could see additional benefits down the road.

"I think it helps everyone when we get additional people covered because it increases the buying power of those individuals," Showalter said.

Additional buying power means the potential for costs to fall across the board.

If you typically spend a lot of money on prescription drugs, Showalter recommended opting for a plan with lower out-of-pocket limits. He's urging those ready to enroll in MNsure to take advantage of federal subsidies, which could cut their drug costs significantly.

MNsure officials said additional information on prescription drug costs and coverage will be available on Oct. 1, when the exchange officially opens. In the meantime, the most detailed information is available on the Minnesota Department of Commerce's website.

The Kaiser Family Foundation found Minnesotans filled nearly 63 million prescriptions at pharmacies in 2011. That's nearly 12 per person, per year -- just below the national average. The average cost for a prescription at a pharmacy in Minnesota was just over $52 -- again, less than the national average. Over a full year, the average Minnesotan spent over $615 on prescription drugs at pharmacies in 2011.