HHS Proposed Drug Coverage Standard For State Exchange Plans Is Well Below Currently Available Coverage – Avalere Study
This article was originally published in The Pink Sheet Daily
Executive Summary
Study finds that HHS’ proposed minimum standard of one drug per class on plan formularies could result in drug coverage that is significantly more limited than what is currently offered in the individual and small group market.
You may also be interested in...
HHS Essential Health Benefits Standard Would Allow Plans To Cover One Drug Per Category
Released Dec. 16, the HHS bulletin previews the regulatory approach the department plans to propose to define covered services under the EHB standard, which must be followed by plans participating in state-based insurance exchanges that will start operating in 2014 under the Affordable Care Act.
Medicare Spending Forecast For Leqembi Reflects CMS Angst About Alzheimer’s Drug Costs
The agency’s projection that Medicare will spend $3.5bn on Leqembi in 2025 is nearly three times the level of sales that marketer Eisai is expecting for the drug in North and South America combined in its fiscal year 2026.
Biosimilar Substitution In Medicare Part D Formularies Mid-Year Established In Final Rule
Policy may be helpful in promoting acceptance of follow-ons in Medicare but is not expected to result in near-term savings to the program.