The state of exchanges
Unanswered factors that will affect drug use in state healthcare exchanges
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...