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Two Industry Experts Discuss Pharmacy Benefit Design on Health Insurance Exchanges in Aug. 1 Webinar

Washington, DC (PRWEB) July 24, 2013

Pharmaceuticals are one of 10 essential health benefits that must be included in small-group and individual products sold on insurance exchanges. But as the Oct. 1 open enrollment date approaches, many insurers still have questions about how the pharmacy benefit will be structured and ultimately operate. Two leading industry experts will discuss the latest requirements and information related to the drug benefit on the exchanges in “Pharmacy Benefits and Exchanges: Balancing Access With Cost in the New Marketplaces,” the upcoming Aug. 1 webinar from Atlantic Information Services, Inc. (AIS).

In the final run-up to the start of enrollment in October, some industry observers say it’s still unclear whether plans will be able to modify their formularies once the lists have been established. By contrast, insurers operating outside of the exchanges have long been able to change formularies during a plan year. Further complicating the picture is the ACA rule that requires all plans on the exchanges to match the level of benefits offered by a “benchmark” plan in a state. For the drug benefit, this could result in significant state-to-state variation in what minimum coverage will look like.

John Jones, senior vice president of professional practice and pharmacy policy at OptumRx, and Caroline Pearson, a vice president at Avalere Health LLC, in addition to discussing the latest information, will explain how to create attractive products that offer ample drug coverage in exchanges while keeping costs down. Participants in the Aug. 1 webinar will learn:

  • How much flexibility can state-selected benchmark plans provide insurers when it comes to designing drug benefits?
  • Will the drug coverage requirements allow for aggressive price negotiation between drug manufacturers and insurers and/or the PBMs that negotiate on their behalf?
  • What pharmacy benefit requirements must health plans take into account as they design essential health benefits packages for state-operated and federally facilitated exchanges in 2014?
  • What are some of the ways insurers can use prescription drug benefits to differentiate their products for 2014? How can they avoid adverse selection?
  • Will plans that are required to have open formularies face a tougher time managing drug costs, and what kinds of management tools will they be able to implement?

Visit for more details and registration information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

Shelly Beaird-Francois
Atlantic Information Services, Inc.
202-775-9008 ext. 3064

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