California Senate considers cap on out-of-pocket drug costs
A bill to cap patients’ out-of-pocket costs for prescription drugs that passed the California State Assembly will be considered by the state Senate this month,
as policymakers across the country wrestle with the growing problem of unaffordable drugs.
The bill would limit patients’ monthly costs to $250 for a 30-day prescription. It also would bar insurers from placing all drugs for any condition in the highest tier of cost sharing. Earlier this year, Covered California imposed a $250 a month prescription co-pay cap for plans sold through the state-run exchange. The new bill would extend that cap to all fully insured plans.
State Assemblyman Rich Gordon, a Democrat, said the bill was inspired by stories he heard about patients with serious chronic conditions who couldn’t afford their specialty medications. The Affordable Care Act caps annual out-ofpocket spending in individual-market plans at $6,600 for individuals and $13,200 for families. But some people were hitting those limits in one month.
“We were hearing individuals were not taking their medications because they couldn’t pay,” Gordon said.
The Pharmaceutical Research and Manufacturers of America group has expressed support for drug caps. But the insurance industry, which would have to pick up the tab, warned that drug caps would drive up premiums. “Without addressing the root cause of drug prices, imposing out-of-pocket caps will give drugmakers the green light to charge whatever they want,” a spokeswoman for America’s Health Insurance Plans said.
Lawmakers in a number of other states also are considering drug caps, though similar measures in Mississippi and Virginia failed this year.