24-1220m Find Out How AB 948 Affects Tiers on the Drug List
Date: 11/19/24
For most members, this bill won’t increase their drug copay
California Assembly Bill (AB) 948 introduces changes to drug formulary tier descriptions.
How this affects drug copays
Tier changes effective starting January 1, 2025, will cause some members to have a lower copay due to their drugs being classified at a lower tier, while others may have higher copay because their drugs are placed at a higher tier.
Member notification
As of November 1, 2024, Health Net notified members whose copay will change as of January 1, 2025.
Key aspects of the bill
Notable effects of AB 948 include:
- Copayment limit – The bill restates a maximum copay of $250 for essential health drugs for a 30-day supply.1
- Prescription drug tier definitions – AB 948 provides clear definitions for the tiers of prescription drugs.
- Cost sharing for generic drugs – The legislation mandates that the lowest cost-sharing option will apply to generic equivalents of brand-name drugs, regardless of whether both are included on the formulary or drug list.
Drug tier descriptions
Refer to the following chart for clarified descriptions of each tier.
Tier | Description |
|---|---|
1 | Tier 1 consists of most generic drugs and low-cost preferred brand name drugs. |
2 | Tier 2 consists of nonpreferred generic drugs, preferred brand name drugs and any other drugs recommended by Health Net’s pharmacy and therapeutics committee based on safety, efficacy and cost. |
3 | Tier 3 consists of nonpreferred brand name drugs or drugs that are recommended by Health Net’s pharmacy and therapeutics committee based on safety, efficacy and cost, or that generally have a preferred and often less costly therapeutic alternative at a lower tier. |
4 | Tier 4 consists of drugs that the U.S. Food and Drug Administration or the manufacturer requires to be distributed through a specialty pharmacy, drugs that require the enrollee to have special training or clinical monitoring for self-administration, or drugs that cost Health Net more than $600 net of rebates for a one-month supply. |
View the bill online
Access the full bill online at Assembly Bill No. 948.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Line of business | Phone number | |
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO |
1FDA Publishes List of Essential Medicines, Medical Countermeasures, Critical Inputs Required by Executive Order.
This information applies to Physicians and Participating Physician Groups (PPGs).