Health Business Daily: CMS Might Take Deeper Dive Into Outlier Drug Costs to Find Discriminatory Designs (with Chart: More Plans Put Chronic Condition Drugs on Specialty Tier)

Health Business Daily: CMS Might Take Deeper Dive Into Outlier Drug Costs to Find Discriminatory Designs (with Chart: More Plans Put Chronic Condition Drugs on Specialty Tier)

By Steve Davis

CMS is now reviewing 2016 plan designs for individual policies sold on and off of exchanges, and is expected to send deficiency notices to some carriers by the end of June. Recent actions in Florida and California to eliminate potentially discriminatory pharmacy benefits could prompt CMS to pay closer attention to qualified health plans (QHPs) that might create financial barriers for populations with costly chronic diseases, industry observers tell HEX.

On May 21, the board of California’s state-run insurance exchange voted to cap prescription drug copays between $150 and $500 per month, with the majority capped at $250 (see story, p. 8). Last fall, the Florida Office of Insurance Regulation (FOIR) called on several insurance carriers to reclassify certain HIV/AIDS medications. Read the full article here. »

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