Dec. 6 Webinar: Industry Experts to Review HHS Proposed Rule on Pharmacy Benefits Under Insurance Exchanges

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Two industry experts will review HHS’s recent release of several proposed rules outlining EHB requirements on health insurance exchanges and how pharmacy will fit into benefits packages in a Dec. 6 webinar sponsored by Atlantic Information Services.

A proposed rule issued by the U.S. Department of Health and Human Services on Nov. 20 could increase the number of prescription drugs health plans are required to cover in products offered through insurance exchanges. In “Essential Pharmacy Benefits for Exchanges: Benefit Design Strategies,” a Dec. 6 webinar sponsored by Atlantic Information Services, two industry experts will discuss this new rule and the challenges it presents to benefit design.

Prescription drugs are one of 10 essential health benefits that must be included in small-group and individual products sold on health insurance exchanges in 2014, but HHS’s proposed rule holds plans to a higher standard that requires covering the greater of one drug per eligible class or the same number of drugs as are covered by a state’s chosen “benchmark” plan. Most EHB benchmark plans picked by states cover more than two drugs per class, and the average benchmark plan covers 62% of the drugs in an eligible class. Now that plans are on the hook for creating a more substantial pharmacy benefit than initially expected, their ability to contain costs could be affected.

In this Dec. 6 webinar, John Jones, senior vice president of professional practice and pharmacy policy at OptumRx, and Caroline Pearson, a director at Avalere Health LLC, who leads the consulting firm’s efforts to track implementation of the Affordable Care Act (ACA) at the state level, will outline EHB requirements related to pharmacy, the challenges associated with benefit design and the keys to successful implementation. Some of the questions they will address include:

  • How much flexibility can state-selected benchmark plans provide insurers when it comes to designing drug benefits?
  • Will the revised drug coverage requirements allow for aggressive price negotiation between drug manufacturers and insurers and/or the PBMs that negotiate on their behalf?
  • What kinds of new partnerships are likely to form between PBMs and health plans as a result of exchanges?
  • How will states build their purchasing websites? How are they thinking of it in terms of a sales proposition?

A concluding question-and-answer session will give webinar attendees the opportunity to get individualized, reliable answers to their questions about balancing cost with access when it comes to prescription drugs in benefit designs.

Visit for more details and registration information on “Essential Pharmacy Benefits for Exchanges: Benefit Design Strategies.”

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

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Shelly Beaird-Francois
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