Not All Drugs for A Disease Could Be High-Cost Under New California Proposal

The bill, AB 339, would prevent health plans from putting all medications used to treat a certain condition into the highest cost prescription drug tier.

Democratic Assemblymember Richard Gordon says insurance companies often put the highest-priced drugs into a specialty tier, requiring patients to pay a higher share of the drug’s price.

“So if I have HIV, and all of the HIV drugs are in a very expensive top tier category, that would appear to be discriminatory,” says Gordon.

But Nicole Kasabian Evans of the California Association of Health Plans says some patients pay a higher share of specialty drug costs because the price of those medications can be many times more expensive.

“Bills like this give a false sense that drug costs are going to be reduced, when in reality costs are just shifted from your out of pocket costs to premiums,” says Evans.

The health plans say a more meaningful way to reduce drug costs would be to convince pharmaceutical companies to charge less, and be transparent about how they price drugs.

They say out-of-pocket expenses are already capped for consumers under the Affordable Care Act.