ESSAY: Additional transparency needed in state health care exchanges

By Charis Hill

Implementation of the Affordable Care Act and the opportunity to enroll in Covered California came at a critical moment in my life. I had recently been diagnosed with Ankylosing Spondylitis, a chronic and severe form of arthritis that might previously have meant that I would have been denied health insurance coverage.

I was relieved that Covered California would give me the opportunity to select an insurance plan and seek treatment for my condition, but I was concerned about the affordability and accessibility of the prescription medications I need to manage my condition.

As I navigated the process of selecting an insurance plan, much of the information that would have been critical to someone living with my condition, including information about drug coverage and cost, was not readily available.

I discovered the Covered California website did not clear information on the drug formularies offered by participating insurance plans. My confusion ultimately resulted in being bumped into a default plan. It was not until I tried to obtain my next supply of medication that I found my out-of-pocket cost had skyrocketed from $5 to $2,000 for a one-month supply.

The goal of the Affordable Care Act was to improve transparency in health benefits. The absence of easily accessible coverage information on the Covered California website is a significant problem for patients like me.

There is, however, a common-sense solution. Senate Bill 1052, introduced by Sen. Norma Torres, will require health plans to provide links to their prescription drug formularies and to use a standard format to display their formularies that will make it easier for consumers to access information about medication coverage, potential access barriers, and out-of-pocket costs for each medication.

Enabling access to health care was a great first step towards assisting the many Californians with preexisting conditions. Ensuring that patients have access to the information they need when making the critical decision of which health plan they should choose is a natural second step.

On behalf of patients like me, I urge Gov. Jerry Brown to sign SB 1052.

Charis Hill is a resident of Sacramento.

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