Monday, June 24, 2013
With the Oct. 1 deadline for
opening enrollment fast approaching, uncertainty abounds around whether state
healthcare exchanges will add significant numbers of new patients into the
prescription drug pool and how it could affect biopharma revenues in the years
to come. But an upcoming review by CMS of insurance plans that have been
submitted to the exchanges could provide some clarity around what limits payers
can place on drug access and affordability.
This week, CMS will review
plans that have been submitted to state health exchanges to ensure that the
proposals meet the requirements dictated by each state's benchmarks. The agency
is expected to decide whether cost-containment practices like prior
authorization or step therapy will be permitted.