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Covered California Considers Capping Specialty Drug Prices For Consumers

Sam-Cat / Flickr

Sam-Cat / Flickr

Consumers wouldn't pay more than $500 per prescription for specialty drugs under a current proposal prepared by California's health insurance exchange staff.

For some plan holders, that cap would be lower.

Some Silver plan holders would pay no more than $200 for specialty drugs placed on the highest-cost tier, and Platinum plan holders would pay no more than $300 per high-cost prescription.

Bronze plan holders would pay no more than $500 for any prescription drug under the current recommendations.

Health insurers and consumer advocates worked with the health insurance marketplace to come up with a way to make drugs more affordable, especially for people who need long-term treatment.

Anthony Wright of Health Access says right now, people with chronic conditions like Multiple Sclerosis or Hepatitis C may be paying more for drugs that are in a higher-priced tier.

"It's inequitable that people with certain conditions have thousands of dollars more in costs than people with other conditions in our current system without these caps," he says.

The Covered California Board of Directors is expected to vote on the cap proposal Thursday, which would apply to 2016 plans.

A bill moving through the California legislature, AB339, also seeks to limit the cost of drugs to consumers. That measure would apply to all commercial health insurance regulated by the State of California.


Pauline Bartolone


Pauline Bartolone has been a journalist for more than 15 years, during which she was Capital Public Radio’s healthcare reporter from 2011-2015. Her work has aired frequently on National Public Radio.  Read Full Bio 

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