Dec 04, 2024
Recent implementation of California Regulation AB 948, which went into effect in 2024, introduces important changes to the descriptions of drug tiers for California Commercial and Marketplace plans that utilize 4-tier formularies.
Key aspects of AB 948 include:
- Removal of the word “biologics” from the definition of Tier 4 drugs.
- Cost sharing for generic drugs: The legislation mandates the lowest cost-sharing that will apply to generic equivalents of brand-name drugs, regardless of their inclusion on the formulary.
As a result of these changes, some members may have lower copayments due to their medications being classified at a lower tier. Others may face higher copayments because their drugs are placed at a higher tier.
Notably, less than 2% of members will see an increase in copayment. And those affected were notified by November 1, 2024, with changes taking effect on January 1, 2025.
- The Customer Contact Center has been informed and providers will be notified prior to January 1, 2025, through a provider update.
- This change does not impact UC as they will move from a 3-tier benefit to a 4-tier benefit.
