It feels to me the same as the "pre-existing condition" issue.
It's not good that people had to get a more expensive rider for those conditions to be covered and made their care more expensive. But look at what the ACA did by eliminating the exclusions. Is there a single person who had a rider paying less in 2019 then they did in 2008 (inflation adjusted)? Fat chance! We're all paying substantially more.
I don't know how this cost will be eaten up front: pharmacy, pharma company, health insurer, providers? Ultimately will be all payers and we'll all pay more.