Dive Brief:
- California's health exchange is aiming to put high-priced specialty drugs within reach of enrollees by capping the amount they will have to pay for prescriptions. It is the first exchange to make this move.
- Beginning in 2016, Covered California enrollees with silver and platinum plans will typically pay a maximum of $150 or $250 per prescription each month; those with bronze plans will pay $500. The change is set to be reviewed in a year.
- The California Legislature is considering a bill, AB 339, to provide similar protection to those covered under employer-based plans.
Dive Insight:
California's actions come at a time of increased scrutiny on the issue of specialty drug accessibility and while several other states are ooking at possible caps as well.
However, while such caps may aid affected enrollees in the near-term, they do not resolve the underlying issue of the drug prices set by pharmaceutical companies, says Nicole Kasabian Evans of the California Association of Health Plans.
As Evans told NPR, insurers will still be facing the full price of the dugs and will only be able to balance their books by raising premiums across the board for health plan members.
"So, if we really want to make sure consumers can afford prescription drug coverage," she says, "then we need to deal with the root price of the drug."