Assembly To Consider Bill Capping Out-of-Pocket Rx Drug Costs

The Assembly this month will consider a bill (AB 339) that aims to cap out-of-pocket costs for prescription medications, Modern Healthcare reports (Dickson, Modern Healthcare, 7/4).


Prices for specialty drugs for the treatment of serious or chronic conditions have soared in recent years.

Specialty drugs represent 3% of brand-name drugs dispensed over the past five years, but they account for 73% of prescription drug spending growth, according to an Assembly Committee on Health analysis.
Details of Bill

AB 339, by Assembly member Rich Gordon (D-Menlo Park), would place limits on how much health plans can charge enrollees for outpatient prescriptions.

Under the bill, outpatient drug costs paid by members would be capped at 1/24th of the annual out-of-pocket limit for a 30-day supply.

AB 339 also would require health plans to use specific formulary tiers.

In April, the Assembly Committee on Health voted 11-5 to approve the bill (Vesely, California Healthline, 4/29).
Opposition of Price Caps

Insurers have pushed back against price caps, saying they could drive up insurance premiums.

A spokesperson for America’s Health Insurance Plans said, “Without addressing the root cause of drug prices, imposing out-of-pocket caps will give drugmakers the green light to charge whatever they want” (Modern Healthcare, 7/4).