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California Healthline, Monday, February 23, 2015

Kaiser Permanente has announced plans to reverse a policy that increased patients’ shares of the cost of certain drugs to treat HIV, a move that advocates hope other insurers will follow, the San Francisco Chronicle reports.


Under a new drug payment plan that went into effect on Jan. 1, Kaiser shifted various medications — including those for certain chronic conditions, such as HIV — into a specialty-tier classification (Allday, San Francisco Chronicle, 2/20). As part of the shift, patients were charged a copayment of 20% of the cost of the drug each time it was filled, rather than a fixed copayment amount (Bartholomew, San Francisco Examiner, 2/23).

Because specialty drugs typically are more expensive, a patient’s share under the new payment plan could have increased up by hundreds of dollars, according to the Chronicle.

Details of Reversal

After receiving backlash from patient advocates and politicians, Kaiser on Friday announced that it would no longer increase the cost of certain HIV drugs (San Francisco Chronicle, 2/20).

Instead, the prescription drugs will return to a brand tier, in which patients are responsible for a fixed copayment (San Francisco Examiner, 2/23).

In addition, Kaiser announced that it would:

  • Refund payments to some patients who had purchased applicable drugs in January; and
  • Work with Covered California and other insurers to reconsider payment plans for other specialty drugs.

The decision did not reclassify other drugs that were moved into the specialty-tier under the same payment plan, according to the Chronicle.


Courtney Mulhern-Pearson, director of state and local affairs at the San Francisco AIDS Foundation, said, “We’re relieved and also really pleased that [Kaiser] listened to the community and did what we think is the right thing.”

Meanwhile, San Francisco Supervisor Scott Wiener (D) said that he plans to hold a hearing on high prescription drug costs that patients still face. He said while he was “grateful that Kaiser reacted so quickly,” the” issue is broader, it goes beyond HIV drugs. And it’s not just Kaiser.”

Wiener added, “We’re going to have to continue to work with all of the health plans” (San Francisco Chronicle, 2/20).

Source: California Healthline, Monday, February 23, 2015

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