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Variation in Out-of-Pocket Drug Costs in Covered California


Consumers with chronic diseases face challenging trade-offs when choosing health coverage, especially when it comes to out-of-pocket drug costs.

Health plans offered through Covered California in 2014 had a significant variation in prescription drug coverage, particularly for drugs treating medication-reliant chronic conditions. Researchers with the California Healthcare Foundation determined consumers' out-of-pocket costs were affected by this variation and formulary design. Because of specialty tier costs and deductibles. medication-reliant consumers, regardless of their income, faed front-loaded spending at the start of the year, according to the report.

In addition, consumers will medication-reliant chronic conditions, such as bipolar affective disorder and rheumatoid arthritis, experienced higher out-of-pocket costs than those who don't use specialty drugs.

According to the Foundation, Covered California will be taking steps for the 2016 benefit year to addresses these concerns about high out-of-pocket costs for some prescription drugs. Prescription drug formulary placement is the primary source of out-of-pocket cost variation across plans because California standardizes benefit designs.

Read more at the California Healthcare Foundation: http://bit.ly/1Lz76Sx

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