AIS Health interviewed Manatt's Joel Ario, a managing director with Manatt Health, for an article on CMS' review of 2016 plan designs for individual policies sold on and off of health exchanges. The agency is expected to send deficiency notices to carriers by the end of June.
AIS Health reports that recent actions in Florida and California to eliminate potentially discriminatory pharmacy benefits could prompt CMS to pay closer attention to qualified health plans that might create financial barriers for populations with costly chronic diseases.
Benefit-design discrimination is a new issue for CMS, as well as for state regulators. "And it's a challenging one," said Ario. "I think [CMS] certainly will scrutinize [2016] plan designs, but where exactly the line is to be drawn is an open question," he said. "If it's clear cut that all drugs are treated equally, with the exception of a few drugs that have a very specific applicability for a very specific population, then I think you would see action on it. But if there's a wide range of drugs, and the argument is whether a particular set of drugs is treated differently, then it's harder to draw that line."