A New Attempt Emerges To Bridge GOP Divisions On AHCA (Updated)

April 21 Update: New Aid For State Formulary Review At REGTAP On April 17, 2017, CMS announced that it would be turning the job of drug formulary review for qualified health plans over to state regulators in the thirteen HealthCare.gov states that have plan management responsibility.  On April 19, CMS offered at its REGTAP.info website (registration required) a seminar on the qualified health plan (QHP) application review tools for prescription drugs that the states may use for these reviews. The EHB Category and Class Drug Count Tool, which is new for the 2018 QHP review period, reviews drug lists to ensure that QHPs comply with essential health benefit requirements. EHB regulations require that health plans cover the greater of one drug in each USP category or class or the number of drugs in each USP category or class covered by the state’s EHB benchmark plan. The Formulary Review Suite reviews the drug list of each plan to ensure that the plan’s benefit design or benefit design implementation (including marketing practices) does not discriminate on the basis of age, expected length of life, present or predicted disability, quality of life, or other health conditions.  Non-discriminatory formulary outlier review identifies plans that have unusually low numbers of drugs that are not subject to prior authorization or step therapy requirements in twenty-seven USP categories and classes.  Non-discriminatory clinical appropriateness review analyzes the availability of dru...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Following the ACA Insurance and Coverage Source Type: blogs