Senator Scott Wiener (D-San Francisco) announced Senate Bill 1021, which will keep out-of-pocket drug costs low for consumers by preserving and strengthening existing drug pricing protections. SB 1021 does this by permanently extending drug co-pay limits and prescription drug pricing standards put in place in 2015 under a bill (AB 339) authored by Assemblymember Rich Gordon, which are currently set to expire at the end of 2019. SB 1021 also strengthens these protections, including by ensuring these pricing protections apply to HIV prevention drugs.
SB 1021 is sponsored by Health Access and co-authored by Senator Toni Atkins (D-San Diego.) It is supported by public health advocacy organizations, including the San Francisco AIDS Foundation, APLA Health, and the California LGBT Health and Human Services Network.
Prior to the imposition of these protections under AB 339, consumers often were paying $6,000 in one month alone for badly needed medication. SB 1021 permanently extends the drug co-pay limits of $250 for a 30-day supply. The bill also makes permanent drug pricing standards that keep insurance companies from routinely placing specialty drugs on their highest pricing tiers.
SB 1021 also ensures that the provisions of the bill cover drugs such as PrEP that prevent the transmission of HIV/AIDS, not just those that treat it. PrEP (pre-exposure prophylaxis), if taken consistently, reduces the risk of HIV transmission by nearly 100%. In 2014, Senator Wiener, then a member of the San Francisco Board of Supervisors, became the first elected official to announce he was on PrEP, in hopes of spreading awareness and reducing stigma regarding PrEP.
“People living with serious health conditions should be able to focus on staying healthy and taking care of themselves, not living in fear that their life-saving medications are going to bankrupt them,” said Senator Scott Wiener. “In addition, maintaining access to prevention drugs like PrEP that can effectively eliminate the risk of transmission HIV is absolutely crucial to keeping people healthy. Nobody wants people living with multiple sclerosis or HIV or cancer to be forced to choose between paying for life-saving medication or putting food on the table. We need quality, affordable healthcare in California, and SB 1021 will help control the costs of expensive prescription drugs for consumers. ”
“California consumers need to be protected from extreme prescription drug co-payments, and other barriers that get in the way of patients getting the medications they need,” said Anthony Wright, Executive Director of Health Access. “Making sure California’s caps on co-pays continue will prevent patients that need high-cost medications, whether if they have MS or HEP-C, from facing a financial shock at the beginning of the year, or having to skip taking a needed pill.”
Before AB 339 went into effect, California residents with serious and chronic conditions like cancer, HIV/AIDS, multiple sclerosis, and lupus were particularly vulnerable to higher out of pocket costs for their medication. Specialty prescription drugs were often placed on the highest tier in the drug pricing formulary, which put them out of reach for many patients.
SB 1021 also adds several provisions not included in AB 339. In addition to ensuring AB 339 pricing protections apply to HIV prevention medication, SB 1021 also codifies an existing Department of Managed Health Care regulation that prevents the cost of a drug copay from exceeding the retail price. Finally, SB 1021 limits the number of tiers in health plans’ formularies to four, consistent with Covered California and Medicare formulary standards.
“San Francisco AIDS Foundation supports Senator Wiener’s bill to ensure that consumers, including people living with and at risk for HIV, continue to be protected against rising copays that otherwise could put medically-necessary drugs out of reach,” said Joe Hollendoner, San Francisco AIDS Foundation CEO. “Before AB 339 was enacted, health plans could put HIV and hepatitis C drugs on the specialty tier and require consumers to pay as much as 20-30% of the cost of the drug every month. Senator Wiener’s bill, which makes the protections under AB 339 permanent, is a practical and critical step forward to support the health and wellness of all Californians.”
“APLA Health strongly supports Senator Wiener’s bill to extend limits on drug copays and require plans to cover the most effective medications for HIV treatment and prevention,” said Craig E. Thompson, CEO of APLA Health. “As insurers increasingly shift the cost of expensive medications to consumers, this kind of legislation is absolutely critical to ensuring that Californians with chronic illnesses, including those living with HIV, can maintain access to the life-saving drugs they need to live healthy and productive lives.”
“The California LGBT Health and Human Services Network is happy to support SB 1021 by Senator Wiener,” said Amanda Wallner, Director of the California LGBT Health and Human Services Network. “This bill is an important piece of the puzzle in ensuring that LGBTQ Californians can afford to access necessary medications and in reducing health disparities throughout our communities. LGBTQ Californians are more likely than the general public to live in poverty and to report lacking the money needed to pay for health care. This is especially true for transgender people, LGBTQ people of color, women, immigrants, and LGBTQ people in rural areas. SB 2021 extends protections that have made health care more affordable for our communities and anyone in California who has struggled with the high cost of prescription drugs.”