EHB Prescription Drug Standard – Exceptions Process

Executive Summary

Introduced by the Affordable Care Act (ACA), Essential Health Benefits (EHB) are a set of ten health care service categories that plans must cover. One of the ten categories of benefits is prescription drugs.

On February 20th, 2015, the Department of Health and Human Services (HHS) issued the Notice of Benefit and Payment Parameters for 2016 final rule (Final Rule 2016), which finalized changes to the EHB standard. The Final Rule 2016 significantly modified the EHB prescription drug requirements.

This fact sheet, focusing on the exceptions process, is the second in a series of NHeLP fact sheets describing the EHB prescription drug standard.