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AMCP Urges HHS to Allow Flexibility in the Design of Prescription Drug Benefits Under Health Care Reform Law
Date:11/10/2011

ALEXANDRIA, Va., Nov. 10, 2011  /PRNewswire-USNewswire/ -- The Academy of Managed Care Pharmacy (AMCP) is urging the Department of Health and Human Services (HHS) to allow health plans flexibility in designing the prescription drug benefit that will be required under the new health care reform law.

Based on the 2010 Affordable Care Act, an estimated 30 million individuals by 2016 are expected to obtain health insurance from private health plans participating in state insurance exchanges, as well as through state expansion of Medicaid programs.

These plans will contain a federally-determined "essential health benefits package," which includes prescription drugs.

In a recent letter to HHS, the Academy said it applauds the classification of a prescription drug benefit as one the essential benefits. At the same time, AMCP encourages HHS to include not only access to medications, but the management of medication therapies under this benefit. In addition, AMCP proposes that health plans maintain autonomy over the design of the drug benefit and the determination of which drugs are to be covered and deemed essential.

"Regulators should not define or require specific drugs or drug categories for inclusion or exclusion under the essential health benefits provision," AMCP argues. "Instead, health plans should be allowed flexibility in determining appropriate coverage."

"Flexibility in making prescription drug coverage decisions, and in designing the overall pharmacy benefit, will allow health plans to incorporate a range of best practices that have shown to improve clinical outcomes and control costs," says Edith A. Rosato, R.Ph., IOM, AMCP's new Chief Executive Officer.  

"Access to medications, along with their proper management, can reduce morbidity and mortality associated with many common diseases and conditions," she adds.

Management of drugs may include such practices as formulary management, medicatio
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SOURCE Academy of Managed Care Pharmacy
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