Pink Sheet Reports on Manatt Health Professional's EHB Benchmark Formularies Analysis

Pink Sheet Reports on Manatt Health Professional's EHB Benchmark Formularies Analysis

"Payers Seek Greater Flexibility in HHS Formulary Standards for Health Plans"
Pink Sheet

January 7, 2013 - Manatt's Ian Spatz, a senior advisor with Manatt Health Solutions, recently spoke at the FDA/CMS Summit, where he presented his analysis on the state essential health benefit benchmark formularies. The Pink Sheet, whose publisher sponsored the Summit, reported on Spatz's analysis.

The Pink Sheet reports that insurance companies and pharmacy benefit managers have urged the U.S. Department of Health & Human Services to drop its proposal to adopt the U.S. Pharmacopeia's Medicare Part D classification system to measure formulary breadth. HHS's proposal to use the USP system is intended to address concerns that benchmark formularies can vary widely among states and may be quite narrow for certain categories.

Spatz' analysis of the state benchmark formularies shows that for more than half of the 163 categories and classes in the USP system, there is at least one state where only one drug is listed. He found significant variation between the high-end and low-end of the spectrum of coverage in many classes.

State-To-State Variability Of EHB Benchmark Formularies For Selected Drug Categories: 

  • Antineoplastics: maximum of 52 covered, minimum of 1
  • Molecular target inhibitors: maximum of 11 covered, minimum of 1
  • Vaccines: maximum of 16 covered, minimum of 1
  • Antidiabetes agents: maximum of 25 covered, minimum of 5
  • Immunomodulators: maximum of 13 covered, minimum of 1
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