By Pauline Bartolone
When 28-year-old Charis Hill discovered that the medication to treat her degenerative arthritis condition had risen to $2,000 a month, she chose to be in pain instead.
“I felt like an invalid,” said Hill, who lives in Sacramento and at the time had only catastrophic health coverage. She said the month without medication made it hard to get out of bed.
Paying for drugs isn’t a problem for Hill now: She has a more robust Covered California health plan, and she gets assistance from a drug company program.
And as of the first of this year, she won’t have to worry about sticker shock if she switches medications. All Covered California plans have a cap on how much patients pay for drugs: $250 a month in silver, gold and platinum plans, and $500 a month in bronze plans.
“I could try a better treatment,” said Hill, a patient advocate, who says she is exploring that because her symptoms are becoming more severe. “The $250 is something I know that I can always fall back on.”
The copay cap on drugs is just one way Covered California chose to shape the health insurance marketplace this year.
Experts say the California exchange uses more of its powers as an “active purchaser” than the vast majority of other states.
That means it can decide which insurers can join the exchange, what plans and benefits are available and at what price.
The federal government — in pending proposed rules for 2017 — has signaled it too wants to have more of a hand in crafting plans. Though there are no plans to go as far as a monthly drug copay cap, healthcare.gov would be forging ahead on a path California already paved, swapping variety for simplicity in plan design. Continue reading