Covered California has moved to limit specialty drug costs, becoming the nation’s first Obamacare operation to offer the protection.
The Covered California board voted for the change May 21, in a policy shift that had been expected. The changes take effect in 2016.
“These new policies strike a balance between ensuring Covered California consumers can afford the medication they need to treat chronic and life-threatening conditions while keeping premiums affordable for all,” said organization chief Peter Lee.
The change addresses a situation in which consumers sometimes had to spend their maximum out-of-pocket expenses on new drugs, such as those that treat hepatitis c. In some cases, a month’s worth of pills would put patients over their maximum. The changes spread the cost out over time. Most of the people who buy insurance via Covered California will see their costs capped at $250 per month, per prescription. “Overall, the caps will range from $150 to $500 (depending on their plans),” Covered California said.
The change affects all health plans handled by the state Obamacare outfit. A bill before the Legislature (AB 339) seeks to extend similar protections to all state residents.
“The improvements come after months of meetings between exchange leadership and consumer organizations, stakeholders, carriers and regulators to determine what is in the best interest of all … consumers,” Covered California said.
The change comes in addition to a system of tiers of drug coverage adopted recently by the board.
Other changes include the addition of a specialist visit without deductible for those in the Bronze health care plans, as well as removal of deductibles for lab tests and rehabilitation. The Silver plan will be simplified by combining copay and coinsurance into a single product. “Every doctor visit, lab test and prescription will not be subject to a deductible in this single product.”
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