The lack of access to clear, consistent and comparable information about health plans in the California Health Benefit Exchange (Covered California) may be jeopardizing several of the goals of the Affordable Care Act (ACA) and making it difficult for California consumers to manage their health benefits.
The Affordable Care Act sought to increase competition in the health insurance marketplace by empowering consumers to more completely and accurately compare available health plans. The ACA also attempted to improve transparency through consumer-friendly tools such as the standardized summary of benefits and coverage. Covered California, however, makes it difficult for consumers to find critical information on prescription drug coverage and patient cost-sharing for the treatments they need.
Patients with substantial prescription drug needs, especially patients living with chronic conditions, need to be able to easily access information and make apples-to-apples comparisons of marketplace health plans. For Californians living with serious and chronic conditions such as cancer, arthritis, multiple sclerosis, HIV, hepatitis C, and many others, making sure the health insurance plan they choose covers the prescription drugs they need is among the most important decisions they will make for their own health.
Because vital information is not readily available on the Covered California website, consumers are instead forced to go directly to the insurers they are comparing. This places an additional burden on California patients. In some cases, they may be able to find the information they need; however, the formularies vary significantly in how information is displayed and what information is provided.
Senate Bill 1052 (Torres) is a common-sense step to help consumers shop for insurance and will make it easier for consumers to understand the available prescription drug formularies. SB 1052 requires health plans to provide links to formularies for non-enrollees and requires that plans use a standard template to display their formularies, including information about potential access barriers ad out-of-pocket costs for each medication.
SB 1052 passed both houses of the California legislature with broad bipartisan support and is currently on Governor Jerry Brown’s desk awaiting signature.