California Sen. Norma Torres, the California Biotechnology Foundation (CBF) and the California Partnership for Access to Treatment (CPAT) held a complimentary luncheon seminar Sept. 8, 2014 at Western University of Health Sciences to discuss health insurance exchange drug formularies in California.
The seminar was designed to educate health care advocates, providers and consumers about insurance plan options, and provide tools for more transparency to help patients select the plan that best meets their health and budget needs.
Torres and Assemblyman Freddie Rodriguez provided opening comments, and College of Pharmacy Dean Daniel Robinson, PharmD, FASHP, welcomed attendees on behalf of WesternU.
Brandon Stephenson with CPAT provided information from the National Health Council. The mission of the National Health Council is to provide a united voice for people with chronic diseases and disabilities.
Covered California is an easy-to-use marketplace implementing the federal Affordable Care Act in California.
The National Health Council’s website PuttingPatientsFirst.net provides transparency in helping people estimate their out-of-pocket expenses based on their health care needs, medication, and potential surgeries or hospitalization.
"We need to keep communicating to people that insurance isn’t scary," Stephenson said. "There are some cultures where seeing a doctor or a mental health provider has a big stigma to it. Collectively, we need to work on those stigmas to make this seem as easy and transparent as possible, so that as people decide what is the best insurance for me and my individual needs and my budget, they’ll know where to go."
Kathy Bellitti, vice president of data operations and quality for Decision Resources Group, which operates Fingertip Formulary, explained that a formulary in its basic form is a list of medications. Most formularies are designated as having tiers based on the cost of the drugs.
The website www.fingertipformulary.com allows users to determine formulary drug status for their health plan. The database is reviewed and updated monthly by pharmacists.
Scott Suckow, Mental Health Systems vice president of development and government relations for Southern California, and steering committee member of the California Chronic Care Coalition (CCCC), talked about Senate Bill 1052. Authored by Sen. Torres, the bill is designed to help consumers more easily shop for health plans based on their prescription drug needs. SB 1052 was approved by the state Assembly and Senate and is awaiting signature by Gov. Edmund G. Brown Jr.
SB 1052 would require a health care service plan or health insurer that provides prescription drug benefits to post those formularies on its Internet website and update that posting monthly. The bill will require the Department of Insurance and Department of Managed Health Care to jointly develop a standard formulary template by January 1, 2017, and would require plans and insurers to use that template to display formularies, as specified. The bill is sponsored by the American Cancer Society and a coalition of consumer and patient groups.
The bill makes sure the consumer’s experience is easier, so they can get accurate information and make an informed choice, Suckow said.
"The best consumer is a knowledgeable consumer," he said. They tell their clients to prepare their questions before arriving for their doctors’ visits. "Make sure your questions get answered. When they’re trying to rush you out the door, if you’re not done, don’t stop. Advocate for yourself.
"We think people with chronic care conditions should not be shopping in the dark," Suckow said. "They should know what their out-of-pocket expenses are, what drugs are on the formulary."