Restrictions on Patient Cost Sharing — AB 339 (Gordon)

May 21, 2015

This legislation requires that copayments, coinsurance and other cost sharing for outpatient prescription drugs be “reasonable” (so as not to deter access and not to reduce compliance with drug regimens, according to the author); prohibits an insurer from placing most or all of the drugs to treat a single condition on the highest tier of a formulary unless there is a therapeutic equivalent drug available in a lower cost tier; and limits cost sharing for an individual outpatient prescription drug to 1/24 of the annual out-of-pocket limit for a 30-day supply. This important legislation has passed out of the Assembly Health Committee and is pending in the Assembly Appropriations Committee.