PCMA Statement on Essential Health Benefits Proposed Rule

The Pharmaceutical Care Management Association (PCMA) released the following statement today on the Department of Health and Human Services (HHS) Essential Health Benefits (EHB) proposed rule:

"While we are still examining the proposed rule, it appears that regulators are rejecting the 'protected class' approach which protects drug companies from competition, gives them unlimited pricing power, and costs Medicare $4.2 billion, according to the Centers for Medicare & Medicaid Services (CMS).

"When plans have more flexibility to design clinically based formularies, they can negotiate bigger price concessions from drug makers and offer more affordable, generous prescription drug benefits to patients.

"As lawmakers seek new ways to avoid the fiscal cliff, they might consider closing the costly 'protected class' loophole in Medicare."

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