Good news… perhaps! If you have health insurance through Covered California (the CA exchange/marketplace), new limits have been set on how much you’ll pay for those expensive monthly “specialty” drugs. Starting January 1st, 2016, you’ll see some upgrades in your prescription benefits.
Covered California ruled that Silver, Gold, and Platinum plans will have a cap of $250 a month per specialty drug. Bronze plans are a little different– there is a yearly $500 drug deductible, and then a $500 monthly cap for each specialty drugs.
What does it mean? If you are one of those people who gets hit hard with expensive specialty drug costs, you might be see some savings starting 1/1/16.
But this new ruling could drive up the cost of health insurance… it’s the nature of the beast. We’ll see.
Covered California did say the biggest problem boils down to the ridiculous and overwhelming costs set by the drug companies. “You can fault the drug companies,” says a smart Covered California official.
Nicole Kasabian Evans with the California Association of Health Plans said the bill could be misleading, noting that patients pay higher shares of specialty drugs because they often are very expensive.
She said, “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.”
Health insurers also contend that out-of-pocket costs already are capped under the Affordable Care Act. They say a better way to address high prescription drug costs would be to have drugmakers be more transparent about how prices are set (“KXJZ News,” Capital Public Radio, 2/18).
The Insurance Mom agrees! What do you think? Did YOU have big prescription costs this year?
