A bill that's intended to help consumers shop for insurance plans based on the prescription drugs they take advanced out of the state senate Thursday, by a vote of 30-6.
Senate Bill 1052, authored by Norma Torres (D-Pomona) strives to fix a problem that anyone taking a drug for a chronic condition may have encountered, according to a Torres spokesman: it's difficult - or almost impossible - to make apples-to-apples comparisons of how insurance plans cover specific medications.
A lack of confidence
A few weeks ago, Impatient readers met Charis Hill, who experienced just that problem.
She takes a weekly shot for a rare form of arthritis. Her prescription cost $5 under one plan; when she was bumped into a default plan, it suddenly cost $2,000. She worked with a certified enrollment counselor to find a new plan, but he had no way of telling how much her medication might cost on various plans.
The fact that even an enrollment counselor could not access this critical information "doesn’t leave the consumer feeling confident in the system, or in their future with their healthcare," Hill told Impatient.
A way out of the 'maze'
SB 1052 directs Covered California to create a search tool on its website, where people could enter their prescriptions, and find which insurance plans cover those drugs. It also requires all health plans to post their drug formularies – in a uniform format – and the costs associated with each drug.
The goal is to give Californians clear information about which health plans cover the prescription drugs that people rely on, Torres said.
"These patients and their families deal with multiple doctor visits and a strict regimen outlined by their doctors," Torres said in a statement. "The last thing they should have to deal with is finding their way through a maze when searching for the drugs they need to keep themselves healthy."
Costly and unnecessary
The California Association of Health Plans opposes the bill. Spokeswoman Nicole Kasabian Evans said health plans already post their drug formularies online, and "it is unnecessary to create a special state law that micromanages how those formularies are displayed."
She said it would cost Covered California up to $5 million to develop a uniform database.
The bill now moves on to the state Assembly. Stay tuned for updates.
Did you or someone you know have trouble determining how much your medication would cost under different insurance plans? Tell us about it in the comment section below, or e-mail us at Impatient@scpr.org.
