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PMA BACKS SEN. BENTSEN’s INSURANCE SMALL MARKET REFORM ADDED TO TAX PACKAGE

Executive Summary

The Pharmaceutical Manufacturers Association supports the health insurance small market reform plan of Sens. Bentsen (D- Tex.) and Durenberger (R-Minn.), PMA stated in a March 2 letter to Bentsen. On March 3, Bentsen's Finance Committee folded the legislation (S 1872) into the committee's larger tax and economic growth package. The package as a whole was approved by the full committee in an 11-9 vote and is slated to be taken up on the Senate floor March 10. PMA's move may help accomplish two goals. Joining the negotiations early gives PMA a say in the shaping of the insurance provisions and may help stave off bills less to the association's liking such as Sen. Pryor's (D-Ark.) S 2000 (see preceding story). The tax package already faces a precarious future due to White House opposition to other provisions it contains. At a March 4 meeting with reporters, Bentsen predicted President Bush would veto the Finance measure, due to conservative opposition to its middle class tax cut and tax increase for individuals in the top income bracket. The small market reform plan has been endorsed by the Health Insurance Association of America. The insurance proposal is seen as an interim step to health care reform. It would not mandate employers to finance health insurance but would require reforms of benefit packages and other measures to make insurance more accessible. The bill would require that health benefits meet minimum standards, to be devised by the National Association of Insurance Commissioners, and would restrict clauses against pre- existing conditions. PMA President Gerald Mossinghoff advised Bentson in the letter that the association's board of directors approved a policy statement that PMA "supports the health insurance reforms that would be achieved" by S 1872. The statement adds that "since prescription drugs are a cost- effective component of total health care, PMA supports inclusion of an outpatient drug benefit in one or more plans which private insurers would be required to offer under S 1872." Contingent "upon available funding sources, such a drug benefit could be required for at least one plan other than the minimum plan. The drug benefit should include some patient cost sharing. It could be designed to cover only catastrophic situations." Consistent with PMA's longstanding opposition to restrictive formularies and therapeutic substitution, the association said that any drug benefit design developed as a result of the legislation "should cover all FDA-approved drugs for labeled and generally accepted uses and should preclude therapeutic substitution formularies and prior-authorization requirements." Uses that are off-label but "generally accepted" could be defined as those listed in the standard drug reference compendia or supported by peer-reviewed medical literature, the letter transmitting the policy statement explains.
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