Proposed rules would allow states to tailor Medicaid benefits for different populations and to implement cost-sharing to encourage beneficiaries to use lower-cost preferred drugs. The proposed rule sets copays at $4 for preferred drugs and $8 for nonpreferred drugs.
States' essential health benefit plans exceed the minimum drug coverage proposed by the Obama administration, according to an Avalere Health study. The plans cover on average 62% of drugs across nine classes, but four states out of the 16 plus the District of Columbia that submitted benchmark plans cover more than 85% of drugs, the study reported.
Employers with fewer than 100 workers might choose to self-insure, thus exempting their plans from PPACA rules including coverage of essential benefits and rules regarding premium increases, according to a study by the Center for Studying Health System Change. The trend could drive up premiums for plans sold on exchanges, the authors said.
The National Community Pharmacists Association, National Association of Chain Drug Stores and three other groups are fighting a proposal in the Senate's bill reauthorizing FDA user fees that would classify commonly abused painkillers as Schedule II controlled substances. The proposal would require a new prescription each time the drugs are dispensed, storage in a safe and regular assessment of inventory.