HHS Proposed Drug Coverage Standard For State Exchange Plans Is Well Below Currently Available Coverage – Avalere Study
This article was originally published in The Pink Sheet Daily
Study finds that HHS’ proposed minimum standard of one drug per class on plan formularies could result in drug coverage that is significantly more limited than what is currently offered in the individual and small group market.
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Released Dec. 16, the HHS bulletin previews the regulatory approach the department plans to propose to define covered services under the EHB standard, which must be followed by plans participating in state-based insurance exchanges that will start operating in 2014 under the Affordable Care Act.
Strategy could improve chances of passage, offer politicians the opportunity to show the public they are doing something to address drug pricing.
House passes Democratic bill authorizing the federal government to negotiate drug prices in Medicare. While the exercise has sharpened the debate over how prices feed innovation, the underlying policy stands little chance of being enacted without a Democratic wave in the next election. Our table highlights the key provisions of HR 3 and other pending pricing legislation.