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‘Essential Benefit’ Drug Coverage Protections Is Next Priority For Patient Group Behind Copay Accumulator Victory

 
• By Cathy Kelly

HIV+Hepatitis Policy Institute provides CMS with a long list of plan sponsors and vendors that appear to be engaged in the practice, which the group argues circumvents the cost sharing protections provided by the Affordable Care Act for hundreds of drugs.

Affordable Care Act Regs Offer Platform For Broader Change • Source: Shutterstock

The Centers for Medicare and Medicaid Services should crack down on all private health plans that engage in the practice of covering drugs but then avoiding some of the cost sharing protections established by the Affordable Care Act by designating the drugs as “non essential” benefits the HIV Plus Hepatitis Policy Institute urged the agency in 8 January comments.

Key Takeaways

  • Many commercial plans are circumventing patient Rx drug cost sharing protections provided by the Affordable Care Act by exploiting flexibility in "essential health benefits" protections, group...

The comments, which call the practice “extremely widespread and growing,” respond to the CMS Notice of Benefit and Payment Parameters for 2025 proposed rule, released in mid-November.

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