What can be done about soaring drug costs?

Joseph BurnsPrimary care physicians concerned about rising drug costs may want to watch efforts in California and other states to cap copayments, and monitor discussions about allowing the federal government to negotiate prices with drug makers or about setting medication prices based on their value to patients.

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One idea, which is being launched in California, is to cap copayments. California’s limit on copayments took effect in 2015. For patients enrolled through California’s health insurance marketplace, Covered California, insurers must limit what they charge for specialty drugs (those on the highest tier) that are purchased retail or through the mail. Insurers may charge no more than $250 for a 30-day supply of specialty drugs for members in silver, gold and platinum-level plans, and no more than $500 for a 30-day supply of specialty drugs for those in bronze-level plans.
Medications patients receive in hospitals or doctors’ offices would have no such caps. Following these changes, state legislators passed a law that similarly limits copayments for those enrolled outside of the exchange.
U.S. Rep. Xavier Becerra (D-California) says Congress should consider legislation to implement such caps on prescription drugs and to allow the Centers for Medicare & Medicaid Services (CMS) to negotiate with pharmaceutical manufacturers for drugs covered by Medicare and Medicaid.  Becerra, who chairs the House Democratic caucus, has formed a task force to address prescription drug pricing. “Any time you see the price of prescription drugs rising so rapidly, particularly for specialty drugs, you have to do something,” he says.

 

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