• Center on Health Equity & Access
  • Clinical
  • Health Care Cost
  • Health Care Delivery
  • Insurance
  • Policy
  • Technology
  • Value-Based Care

Variation in Out-of-Pocket Drug Costs in Covered California

Article

Consumers with chronic diseases face challenging trade-offs when choosing health coverage, especially when it comes to out-of-pocket drug costs.

Health plans offered through Covered California in 2014 had a significant variation in prescription drug coverage, particularly for drugs treating medication-reliant chronic conditions. Researchers with the California Healthcare Foundation determined consumers' out-of-pocket costs were affected by this variation and formulary design. Because of specialty tier costs and deductibles. medication-reliant consumers, regardless of their income, faed front-loaded spending at the start of the year, according to the report.

In addition, consumers will medication-reliant chronic conditions, such as bipolar affective disorder and rheumatoid arthritis, experienced higher out-of-pocket costs than those who don't use specialty drugs.

According to the Foundation, Covered California will be taking steps for the 2016 benefit year to addresses these concerns about high out-of-pocket costs for some prescription drugs. Prescription drug formulary placement is the primary source of out-of-pocket cost variation across plans because California standardizes benefit designs.

Read more at the California Healthcare Foundation: http://bit.ly/1Lz76Sx

Related Videos
A new study finds law enforcement presence in emergency departments may disrupt care. Lead author Prashasti Bhatnagar discusses policy and training solutions.
Jennifer Snow, MPA, NAMI
Jennifer Snow, MPA, NAMI
Aleata Postell, SVP of pharmacy business development, CenterWell Pharmacy
Where patients live may shape outcomes in hypertrophic cardiomyopathy, with SDOH linked to higher risks of heart failure and arrhythmias.
Adam Brufsky, MD, PhD, University of Pittsburgh
Dr Steven Manobianco
Dr Amrita Basu
Danielle Roman, PharmD, BCOP, Allgheny Health Network
© 2026 MJH Life Sciences
AJMC®
All rights reserved.