Covered California postpones vote on drug-cost cap | The Sacramento Bee

Leaders of the state’s health benefit exchange postponed a vote Thursday on capping the amount that patients can pay each month for expensive specialty drugs.

Covered California’s governing board was considering a $500 a month cap on drugs to treat diseases such as hepatitis C and HIV/AIDS. Newer treatments for hepatitis C, a virus that can lead to severe liver damage, have list prices of $1,000 per pill or more.

Patient advocates are urging the board to limit patients’ out-of-pocket expenses to $200 a month. Board members said they wanted to get more input in the coming weeks and possibly make a decision at their meeting next month.

Currently, Covered California sets a maximum yearly limit of about $6,300 in expenses that patients can pay out of pocket, but there are no monthly limits. Patients taking some of the highest priced pills can reach the yearly limit with a single bottle of pills.

The drugs’ huge price tags, and concern that other so-called “blockbuster” drugs could be priced similarly, have triggered a number of policy proposals this year to rein in costs, including Covered California’s proposal and state legislation that would limit patients’ out-of-pocket expenses.