Bee Applauds Proposal to Shift Treatment Risks to Insurers
Weighing in on the debate over whether insurers or physician groups should carry the financial risk of paying for expensive treatments, a Sacramento Bee editorial says that a proposed bill that would shift risk to health plans "deserves consideration." Sponsored by Assembly member Keith Richman (R-Simi Valley), the only physician in the state Legislature, AB 142 calls for health plans to assume the risk for "select" medicines, including injectable medicines such as the new treatment for respiratory syncytial virus, which costs up to $5,000 per month. Under the current system, health plans pay physician groups a "set budget per month" for care services, but the editorial notes that often this amount is not enough to cover a patient's medication needs, leaving doctors "struggl[ing] to pay for prescription drugs out of these budgets." The editorial concludes: "AB 142 doesn't resolve the cost pressures of modern medicine. But Richman, who comes to the Legislature with backgrounds in both medicine and medical group management, is laudably seeking achievable ways to make the system more rational" (Sacramento Bee, 2/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.