Some Essential Benefits Rules Could Worry Small Businesses
(Washington, DC)—As small businesses struggle to afford health benefits, a new employer survey indicates concern that forthcoming Essential Health Benefits regulations could include special interest protections that empower drugstores and drug companies to raise prescription drug costs, the Pharmaceutical Care Management Association (PCMA) said today. Pharmacy benefit managers (PBMs) administer drug benefits for thousands of small businesses throughout America.
The poll surveyed 400 owners and HR managers of small businesses with 100 or fewer employees directly impacted by the upcoming Essential Health Benefits regulations. By a 78 to 11 percent margin, respondents said "small businesses should be able to reduce prescription drug costs as much as possible, even if it means drugstores make less profit." Only six percent were interested in knowing how much drugstores are paid.
Small businesses disagree with the drugstore and drug company lobbies on the following issues:
• Small businesses want access to plans that exclude expensive drugstores from their networks. 61 percent say it is a good idea to "allow employers to choose lower cost plans that exclude the most expensive drugstores from their coverage network."
• Seventy-four percent oppose mandating across-the-board, low co-pays for high-priced drugs. By a 2-1 margin, small businesses think it would be better to require drug companies to offer case-by-case price discounts to those in need.
• Small businesses want to hold drugstores accountable. 88 percent say it is a good idea to "allow plans to audit drugstores that appear to be overcharging."
• Small businesses want access to plans that encourage delivery of prescription drugs through the mail. 79 percent say it is a good idea to "allow plans to offer discounts that encourage employees to get prescriptions by mail."
"On prescription drug issues, regulators will have to choose between small business and powerful special interests who want rules that make employers pay more. When costs go up, it becomes harder for small businesses to offer benefits to their employees," said PCMA President and CEO Mark Merritt.
Next week, the Institute of Medicine (IOM) is expected to offer recommendations to the U.S. Department of Health and Human Services (HHS) on the "essential benefits" regulations. Small businesses will be among those most affected by these rules, which apply to employers that purchase coverage and have fewer than one hundred employees, as well as qualified health plans in the state exchanges.