Consumer advocates are cheering the Obama administration’s plans to strengthen transparency rules (PDF) for provider networks and drug formularies so that insurance exchange customers will be able to make informed choices.
“There are a lot of good things in here that are increasing transparency and adding to access for people with chronic conditions,” Eric Gascho, assistant vice president of government affairs with the National Health Council, said of the draft regulations issued Friday for enrollment in marketplace plans for 2016 and beyond.
Katherine Hempstead, who directs coverage activities for the Robert Wood Johnson Foundation, said it appears that the “CMS really took to heart a lot of things that people were saying.”
Still, the proposal is not without controversy. Plans to scrap the administration’s current policy of automatic re-enrollments and to stick with a fall sign-up season have received less enthusiastic responses.
The CMS said it planned to change the rules that health plans must follow to establish that their drug formularies provide adequate access to pharmaceuticals. The agency wants to require insurers to establish “pharmacy and therapeutics” committees that would meet at least four times a year to review drug formularies. More than half of the panel would have to be made up of healthcare professionals and at least 20% would need to be free of any financial conflicts with insurers or pharmaceutical companies.
“This is a really major improvement,” said Carl Schmid, deputy executive director of the AIDS Institute, which has filed a complaint with the CMS charging that some exchange plans sold in Florida discriminate against customers with HIV. “The only bad thing is that that they’re not proposing it until 2017.”
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Jeffrey R. Ungvary President