Covered California Approves Specialty Drug Cost Caps

The Covered California board approved the price caps on specialty prescription drugs today. Monthly caps will range from $150 to $500 per prescription. Most Covered California consumers will have a cap of $250 a month.

Executive Director Peter Lee says Covered California is the first health exchange in the nation to adopt specialty drug caps.

"We believe these recommended policies strike the right balance between our insuring that Covered California consumers get the medications the need and keeping premiums affordable for all," he says.

Health care advocates at the meeting generally welcomed the caps. But some suggested the upper limit of $500 might be too high.

Board member Marty Morgenstern voted for the caps. But he says pharmaceutical companies are demanding too much for their drugs. 

"There’s no basis for the charges that they have for those drugs or other drugs. They charge what the market will bear," he says. "They charge irrational prices on specialty drugs and on all drugs as a matter of fact."

A representative of the Pharmaceutical Researchers and Manufacturers of America says agencies like Medi-Cal and health plans in the state regularly negotiate the price of drugs.

The new limits on specialty drugs take effect next year.