On Wednesday, Rep. Lois Capps, D-Santa Barbara, applauded Covered California’s efforts to improve access to high-cost specialty drugs.
Last week, the Covered California board announced that starting in 2016 the vast majority of consumers who get their health insurance through the exchange will see the cost of their specialty drugs capped at $250 per month, per prescription.
Earlier this year, Capps reintroduced similar bipartisan legislation, the Patients’ Access to Treatment Act, which would help patients across the country afford necessary treatments by limiting the cost of specialty drugs for patients with chronic conditions.
When insurance companies move drugs into a “specialty tier,” which often requires patients to pay a percentage of the actual cost of the drugs, access to those drugs can become prohibitively expensive. Many of these drugs do not have a less expensive generic equivalent, which means patients are forced to pay hundreds or thousands of dollars each month or go without treatment. The Patients’ Access to Treatment Act would prohibit insurers from imposing exorbitant co-payment, co-insurance, or other cost-sharing requirements on patients who require specialty medications to treat life threatening or chronic diseases.
“I commend Covered California for once again leading the way forward in improving access to quality health care,” Capps said. “Ensuring that all Americans have access to these life-saving specialty medications is critically important. I am hopeful that we can once again follow California’s lead here in Washington and work together to reduce the cost of specialty drugs.”
— C.J. Young is a legislative assistant for Rep. Lois Capps.