California Takes Bold Steps to Improve Patient Access, Safety

June 3, 2015

by Amanda Conschafter, blog editor

The Golden State is making bold strides toward improving health care access and safety for its citizens. Earlier this month, California’s state health care exchange announced a cap on out-of-pocket costs for prescription medications. Meanwhile, the state legislature continues to debate a bill that could make school children’s vaccinations mandatory, minimizing opportunities for public health incidents such as last year’s Disneyland measles outbreak.

Long encouraged by health care advocates, Covered California’s new cap limits 2016 out-of-pocket spending on prescription medications to $150-250 a month for patients covered by Gold, Silver or Platinum plans. The rule also prohibits plans from putting all medications for a specific disease into the specialty tier. Both measures seek to prevent specialty tiers, which require the highest cost-sharing, from pricing patients out of the medications they need.

[WATCH: The Cost of Specialty Tiers]

Roughly 1.3 million people have health coverage through Covered California, but the benefits of an out-of-pocket cap may also extend to those with private health care coverage. California law requires that insurers participating in the exchange offer comparable plans through the private marketplace as well. The first state measure of its kind, California’s cap could serve as a precedent for other states.

Meantime, California also may soon become one of only three states – including Mississippi and West Virginia – to disallow exemptions to vaccine requirements for children in the public school system. State Senate Bill 277 would eliminate personal and religious exemptions for California students, requiring with certain exceptions that students receive the 10 immunizations identified by the state.

Opponents of SB 277 argue that legislators are impeding on their individual rights, while the bill’s supporters say science upholds vaccination’s safety and importance for public welfare. The bill follows an outbreak of measles that began at Disneyland in December 2014. Already passed by the senate, the bill must now clear the California State Assembly and receive Governor Jerry Brown’s signature before becoming law.

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