Modern Healthcare Turns to Manatt Professional on Prescription Drug Coverage Provision

Modern Healthcare Turns to Manatt Professional on Prescription Drug Coverage Provision

"Key Players Fight to Manage Insurance Regs"
Modern Healthcare

November 26, 2012 - Modern Healthcare turned to Manatt's Ian Spatz, a senior advisor with Manatt Health Solutions, for insight into the U.S. Department of Health and Human Services' new proposed rule on prescription drug coverage.

As reported by Modern Healthcare, HHS recently issued a highly anticipated draft rule on the Patient Protection and Affordable Care Act's essential health benefits provision, which describes a set of benefits that all health plans in the individual and small-group markets must include. HHS intends to require health plans to cover the greater of either one prescription drug in every U.S. Pharmacopeia category and class, or the same number of prescription drugs in each category and class that are covered in the essential health benefits benchmark plan. This is a major difference from the proposed rule on essential health benefits that the HHS released last December, which had said that if a benchmark plan offers a drug in a certain category or class, then all plans must offer at least one drug in that same category and class.

Spatz told the publication that HHS stirred a controversy mostly among patient advocates last year by suggesting plans cover only one drug in each category. The change would generally give enrollees the same kind of choices that people have in private-sector plans.

"We'll have to see how this works in real life," Spatz said. "It's not clear how this is going to work out at all. But it really was a way for CMS to get out of a problem they created, which was to suggest a floor that was too low."

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