California: Marketplace Board Approves Co-Pay Cap on Specialty Drugs

The Covered California Board approved a co-pay cap for high-cost, specialty drugs that will limit out-of-pocket expenses after any deductible to $150-$250 per month, per prescription for silver, gold and platinum plans and to $500 per month, per prescription for bronze plans. Covered California is the first Marketplace to implement this type of policy, which will result in premium increases of less than 1% across all plans in the first year according to a Marketplace spokesman. Insurance Commissioner Dave Jones released a statement in support of the specialty drug cap; he noted, however, that he was disappointed that the Board did not cap the bronze plans at $300 as requested and cautioned that prescription drug coverage would be “unaffordable” for bronze plan holders.

Colorado: Marketplace Approves Fee Increases

Connect for Health Colorado’s Board unanimously approved an insurer assessment fee increase from 1.4% to 3.5% and a broad assessment fee increase on plans both on and off the Marketplace from $1.25 to $1.80 per member per month. With the fee increases, which are meant to cover operational, not capital costs, the Marketplace’s total revenue is projected to be approximately $40 million in fiscal year 2015-2016.

South Dakota: Insurers' Proposed Rate Increases for 2016 Vary Considerably

Insurers selling individual plans on and off South Dakota’s Federally-facilitated Marketplace (FFM) submitted proposed rates for 2016, with rate increases ranging from the low teens to 43%, as reported by The Associated Press. Two of the three carriers that offer plans on the FFM reported requested rate increases in the low teens. Wellmark Blue Cross Blue Shield, the State's largest private insurer that does not participate in the FFM, proposed a rate increase of 43% for its 14,000 members with individual ACA-compliant plans, attributing the increase to large medical claims, high prescription drug expenses and members cancelling their plans after costly medical procedures.