PCMA Statement on Essential Health Benefits Final Rule

Regulators Reject Expensive 'Protected Class' Approach in the Exchanges

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

"Regulators rejected the 'protected class' approach that shields competing drug companies from offering competitive pricing to be included on formularies.

"Unfortunately, 'protected classes' are used in Medicare and increase costs by $4.2 billion, according to the Centers for Medicare and Medicaid Services (CMS). There is no evidence that 'protected classes' improve quality or access and they should not be imposed on plans in the Exchanges.

"Plans can negotiate greater price concessions from competing drug makers – and reduce overall prescription drug benefit costs – when they have more flexibility to design clinically-based formularies."

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