Law360 Interviews Manatt Health Professional on Proposed Prescription Drug Coverage Confusion

Law360 Interviews Manatt Health Professional on Proposed Prescription Drug Coverage Confusion

"New ACA Rules Foggy on Drug Coverage, Multistate Plans"
Law360

November 27, 2012 - Law360 interviewed Manatt's Ian Spatz, a senior advisor with Manatt Health Solutions, on the confusion surrounding the U.S. Department of Health and Human Services' newly proposed ACA rule on prescription drug coverage.

Law360 reports that the HHS recently issued three proposed rules implementing the Affordable Care Act: one on the essential health benefits that exchange plans must offer, one on insurance market reforms, such as guaranteed issue, and one on employer wellness incentive programs.

Industry experts noticed one major change on the essential health benefits rule since HHS released a bulletin last December. The bulletin called for plans to cover just one prescription drug per class; however, in the newly proposed rule, HHS instead said plans would have to either offer one drug per class, based on the U.S. Pharmacopeia, or the same number of drugs per class that the state's benchmark plan offers, whichever is greater.

Experts told the publication that the proposed language is far from clear.

The proposed rule also leaves questions about the coverage of generics versus brand-name drugs unanswered, said Spatz.

"HHS created a lot of confusion in the bulletin by suggesting that plans could cover just one drug in each class. I don't think it was their intention. But the alternative could be just as problematic," Spatz said. "I don't think they've set up something that's a whole lot easier to understand."

Read the article here.

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