Prescription Drug Cap

About 7 out of 10 or 70% of Americans take prescription drugs, which is why the discussions surrounding prescription drug costs are so important.

Covered California officials recently proposed a limit on drug costs for consumers who have specialty prescriptions and purchase a 2016 health plan.Their goal is to give these individuals accessible and affordable coverage for their prescriptions.

The proposal would:

  • Place certain drugs in pricing tiers
  • Require health plans to publish pricing information about the prescriptions online
  • Mandate that there must be at least one drug for a particular condition in a lower tier

For example, this would mean that the cost of a prescription for diabetes would have to be published by the health plan online and there must be a prescription available for diabetes in a lower pricing tier (not all diabetes prescriptions could be offered in the highest tier).

According to Covered California officials, this would enable the the exchange to create better recommendations for specialty drug cost limits.

What else did the proposal say?

  • There would be a $500 limit per prescription for specialty drugs in 2016
  • Silver plans would pay $200 at most per specialty drug
  • Platinum plans would pay $300 at most per specialty drug
  • Bronze plans would pay $500 at most for any prescription
  • Gold plans would pay $500 at most per specialty drug

Overall, the primary purpose of these caps is to help decrease the gap of information between the drug maker and the consumer. Drug makers have been increasing the cost of drugs to the point where it is almost unaffordable to the consumer. This policy would better explain the cost of the drug and apply a pricing cap to it.

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