Protect and Lower Health Care Costs

Your health plan is also your advocate for public policies that enhance the quality of your health care coverage while reducing the costs at the same time.

Tackling Rising Prescription Drug Prices

Prescription drug spending growth is projected to increase 4.6% in 2019. Prescription drug costs have skyrocketed and are now the fastest growing contributor to premiums. They continue to be one of the leading factors driving up health care costs for Californians. Health plans are actively advocating for policies and programs to rein in costs.

  • Pay-to-delay agreements, also known as reverse payment settlements, occur when major brand-name pharmaceutical companies pay off generic manufacturers to delay entering their lower-priced generic versions of the drug into the market for a set period of time. Pay to delay agreements take money from patient pockets to unfairly increase drug company profits.
  • AB 824 (Wood) will give Attorney General Becerra greater tools to crack down on pay-to-delay schemes — bringing more generic drugs into the marketplace to ensure all Californians have access to affordable health care.

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Advocating to Stop Unneeded Legislation that will Raise Health Care Costs

Large employers negotiate with their health plans to secure the plan at the cost that best fits their budget and employees’ needs. These large group health plans are highly tailored and competitive, which is why the federal government determined that the regulatory review of large groups is unnecessary under the Affordable Care Act.

Assembly Bill 731 by Assemblymember Kalra will impose unnecessary and redundant bureaucratic reporting requirements over group health plans, while creating uncertainty for employers and employees, and causing cost increases on health insurers and regulators – costs that will be passed on to consumers through higher premiums.

Learn More: AB 731: Added Bureaucracy, costs, and delays

Advocating to Stop Third-Party Health Providers from Gaming the Health Care System and Driving Up Costs for All

  • Unnecessary inflated medical claims drive up the cost of health insurance premiums for everyone. Californians should not have to pay the price for dishonest third parties seeking to financially benefit from unnecessary and inflated medical claims.
  • AB 290 will increase consumer protection and provide transparency about where payments on behalf of patients to dialysis companies and loosely regulated drug rehabilitation centers are coming from, and remove the financial incentive for unscrupulous third-party payers to bill health plans for inflated and unnecessary medical claims.

Learn More on the AB 290 Fact Sheet

Learn More on the AB 290 Infographic

Advocating for Better Policies Instead of Costly Mandates

Health plan premiums directly reflect the cost of goods and services. When the price of medical services goes up, consumer health care costs increase through higher premiums.

  • We support better solutions to provide unique medical services than costly mandates that on average increase every Californian’s health care costs.
  • When policy makers propose numerous costly new benefit mandates, the cumulative costs can reach hundreds of millions of dollars during a time when we should be focused on advocating for policies that improve health care affordability.
  • Health plans are committed to supporting solutions that protect high quality affordable health care while continuing to improve the unique health care treatments and services we provide.

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Advocating for Transparency in Drug Pricing

Health plans championed the nation’s first comprehensive legislation aimed at reducing prescription drug prices by advocating for transparency requirements into Pharma’s pricing tactics that, until this year, have stayed hidden. This will help address the growing affordability crisis by requiring drug companies to give health plans, policymakers, and the public notice of major price increases for the most expensive drugs.

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Advocating to Protect Gains Made Under the Affordable Care Act

  • Health plans supported the passage of a state-based Individual Shared Responsibility Requirement to have health coverage. This new law will help to stabilize the market and generate hundreds of millions in new state funding annually that can be used to help make health coverage more affordable for low-income and working families and individuals in California.
  • The requirement to buy coverage is the best method to stabilize California’s health care marketplace and is a crucial first step that will allow us to move toward finding real solutions to cover the remaining 6.8% of uninsured Californians.

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Join us by writing a letter to your legislator about these legislative policies that will have an impact on you.