(Bloomberg) — Covered California, a state-based public health insurance exchange, changed the designs of its plans to cap policyholders’ monthly copayments for specialty drugs and help curb costs for consumers.
The majority of Covered California’s beneficiaries will have monthly payments for specialty drugs capped at $250 per month, the health exchange said Thursday in a statement. Some caps will range from $150 to $500. Covered California says it’s the first Patient Protection and Affordable Care Act (PPACA) exchange in the nation to adopt this model.
Before the changes, consumers had to reach an out-of-pocket maximum before their insurance coverage kicked in, meaning that with some expensive specialty drugs, customers had to pay for the first few months by themselves — possibly thousands of dollars. This high upfront payment could deter consumers from using specialty drugs.
While a new generation of treatments is now emerging, often with spectacular results in diseases like cancer and hepatitis C, costs are soaring at the same time. More than 30 cancer drugs that hit the market from 2010 to 2014 cost $5,000 a month or more, according to data from Memorial Sloan Kettering Cancer Center in New York. New hepatitis C drugs that can eliminate the virus also have come under scrutiny for their price tags of $1,000 or more per pill, or $84,000 and up for a 12-week course of treatment.
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