American Medical News Quotes Manatt Professional on ACA Drug Benefit Uncertainty
"ACA Minimum Coverage Rule Raises Drug Benefits - And Objections"
American Medical News
December 3, 2012 - American Medical News quoted Manatt's Ian Spatz, a senior advisor with Manatt Health Solutions, on the questions that have been raised regarding a proposed Affordable Care Act rule on drug benefits.
American Medical News reports that a long-awaited proposed rule on the ACA's minimum coverage requirements for health plans seeks to establish more generous drug benefits. Exchange plans will need to cover the same number of drugs as a state's benchmark plan. In the event the benchmark doesn't cover any drugs in a particular class, exchange plans would be required to cover at least one drug in that class. However, questions remain about what types of drugs will be available to patients.
Some uncertainty remains about what types of drugs may be offered under this approach, said Spatz. "What you may be hearing from some of the [patient] advocates is there could be three generic drugs or three brand-name drugs. It could be the latest cancer therapy, or it could be a cancer drug that's been used for many, many years in a category or class."
From the health plans' standpoint, a benchmark plan may have five to seven drugs in a category, but that doesn't necessarily mean a robust drug benefit actually needs that many. "It might be fine to have two or three, if it's the right drugs," Spatz said. He said these decisions probably would not create many problems for physicians who are used to navigating plan drug formularies.