Issue:  Vol. 48 / No. 8 / 22 February 2018

Ma bill takes aim at HIV drug, other co-pays

Democratic Assemblywoman Fiona Ma (pictured at left) has introduced legislation to stop health insurers from dramatically increasing medication costs for many Californians, including people living with HIV.

Assembly Bill 310, introduced February 9, would eliminate specialty tier pricing for medication, place a cap on patient co-pays, and limit the annual out-of-pocket expenditures for California patients.

Ma, whose district includes San Francisco, said that for many years, patients have been charged co-pays based on three drug categories: generic, preferred, and non-preferred.

Then, in 2006, Medicare Part D plans started introducing a fourth level, known as a  specialty tier. The most expensive medications go into this category, and for the past four years, insurers have been “classifying certain drugs as specialty tier and trying to get patients to pay more” for drugs, said Ma.

The specialty tier covers about a dozen drugs, including medications used to treat HIV, multiple sclerosis, and breast cancer, according to Ma.

Rather than paying a flat rate for medication, Californians with medication on new specialty tiers can pay coinsurance of up to 35 percent of the total cost of the drugs.

Ma said, “We are finding some patients now have to pay up to $30,000 a year or more” out-of-pocket, for one drug. The co-pay had been $10, she said.

She said she hasn’t yet looked at co-pays in the AIDS Drug Assistance Program, which the state estimates will provide services for over 42,000 people in 2011-12. Many rely on the program for lifesaving medications.

In January, Governor Jerry Brown proposed, increasing the client share of cost in ADAP to the maximum percentages allowed under the Ryan White HIV/AIDS Treatment Extension Act. That maximum is 5 percent of gross income.

Since Brown announced his budget proposals, meant to cover an 18-month gap estimated at $25.4 billion, advocates for people with HIV/AIDS have been working on the ADAP co-pays.

— Seth Hemmelgarn, February 16, 2011 @ 3:12 pm PST
Filed under: Uncategorized

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