PRESCRIPTION DRUGS: New Law Will Ease Costs for Some Seniors
A new California law, which takes effect next Tuesday, will help defray the drug expenses of seniors who pay out-of-pocket for some or all prescriptions, the Santa Rosa Press-Democrat reports. The new law requires pharmacies to sell prescription drugs to Medicare recipients who lack supplemental drug coverage for the same amount Medi-Cal reimburses the pharmacies. Under this plan, state officials vow seniors will save as much as 40% on individual drugs. State pharmacists predict the average senior's pharmacy bill will drop by no more than 10%. The law's lead sponsor, state Sen. Jackie Speier (D-San Francisco), said that California's higher drug costs exacerbate prescription coverage problems for seniors on fixed incomes -- a problem that "borders on immoral." Speier said the new measure could save low-income seniors roughly $156 million a year, equivalent to pushing a $351-per-month prescription bill down to $223 per month (Smith, 1/25).
HMOs Try Tiered Strategy
As Californians struggle with the high price of prescription drugs, managed care organizations increasingly are adopting experimental tiered co-payment plans to help control costs, the Sacramento Business Journal reports. Consequently, many HMO members are being charged two or three different levels of co-payments, depending on whether a prescription calls for a generic drug, a formulary-approved name-brand drug or a name- brand drug excluded from the HMO's formulary. Because the idea is new, HMO regulators with the state Department of Corporations are monitoring and evaluating the tiered plans on a case-by-case basis, department spokesperson Julie Stewart said. The state will not allow HMOs to charge a percentage of drug costs, citing patient confusion with such a system. Stewart added, "People need to know exactly what they have to pay." Walter Zelman, executive director of the California Association of Health Plans, defended tiered systems, saying, "Everybody is trying to wrestle with the explosion in pharmaceutical costs" (Roberston, 1/24).