California is the first state in the country to impose price caps for specialty drugs. The cap would limit the cost for most enrollees who obtained health insurance from the state exchange to $250 per prescription per month. Currently, enrollees are responsible for costs up to the deductible on their plan, which can add up to thousands of dollars, according to the report.
This decision comes as new, expensive drugs are subject to increasing criticism. For example, Sovaldi, a new treatment for hepatitis C, can cost $84,000 for a 12-week treatment period. According to a March report from Express Scripts, a 13 percent increase in U.S. prescription drug spending in 2014 is largely attributable to new specialty drugs, such as Sovaldi.
“While Covered California is doing its part to protect consumers against these rising costs, a broader solution is needed to curtail the explosion in specialty drug costs so that consumers get the care they need without driving up insurance costs so much that consumers can no longer afford coverage,” said Peter Lee, executive director of Covered California.
While these prices will be controlled for patients, insurers have to pick up the remaining high costs of the drugs.
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