Opinions

Key drug information not on Covered California site

For those living with serious and chronic diseases such as cancer, shopping for health insurance can be one of the most important things they do for their own health. The new federal health care law took several steps to improve this process – most notably removing the ability of health insurers to deny coverage because of a preexisting condition. Despite the progress, choosing which health plan is best for them remains a complicated choice for California patients.

For someone managing cancer, ensuring that the health insurance plan they choose covers the prescription drugs they need is particularly important. All health plans available in health care marketplace, Covered California, must provide a benefit package that includes prescription drugs, but the drugs that are covered can vary by plan.

Currently, important drug information is not currently available on Covered California’s website, forcing interested consumers to go directly to the insurer for answers.

Consumers must consider the kind of health insurance coverage they need and carefully study the kind of prescription drug coverage any plan offers to make sure any drugs they may take now or in the future will not only be covered but also be affordable. Many specialty drugs can be extremely expensive and so ensuring that certain drugs are covered and knowing the estimated out-of-pocket cost may save future stress and money.

The list of drugs or drug formularies offered by insurance plans are increasingly complex but are also vitally important for patients to understand. A difficult reality is that people living with serious and chronic diseases often know what they are looking for in a plan, but the information they need may not available or might be incredibly time consuming to track down.  In some cases, a consumer has to actually sign up for a plan before they can find out how much they have to pay for a needed medication.

Currently, important drug information is not currently available on Covered California’s website, forcing interested consumers to go directly to the insurer for answers.  Occasionally, a patient can find the information on the individual insurer website, but the formularies are displayed differently with each plan, making it difficult to compare plans to each other. In addition, there is no way to compare out-of-pocket costs.

California lawmakers now need to take the extra step to ensure that all patients have the tools they need to shop.

In other states, Colorado for example, the state exchange makes plan drug formulary links easily available to consumers who shop on their website. Our neighbor, Nevada, has been a leader in this area, providing consumers with a tool to search for any drug on any of the plan formularies.  By simply entering the name of a drug, the consumer is shown which available plans cover that drug, any notes or restrictions imposed by the plan.

Senator Norma Torres has authored a bill here in California, which will help ensure that Covered California and qualified health plans make drug coverage and drug formularies publically available, easier to find, understand and compare and, ultimately, more consumer-friendly.  The bill has two main components, including: requiring insurers in the health care marketplace to provide more transparency in their formularies and 2) directing Covering California to create a search tool on their website to allow patients to search by drug or therapeutic condition.

The new health care law has, for the first time, provided consumers with the ability to access quality, and affordable health plans. California lawmakers now need to take the extra step to ensure that all patients have the tools they need to shop, compare and find the plans that provide the best possible coverage for them. Cancer patients, survivors and their families, know all too well how important it is to have affordable coverage for prescription drugs and that coverage can sometimes be the lifeline that helps them survive a cancer diagnosis.

Ed’s Note:  Alison Ramey is director of  State Legislative Advocacy at the American Cancer Society Cancer Action Network (ACS CAN), based in California.


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