Institute of Medicine asks for regulations

Oct. 12, 2011 at 1:07 AM
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WASHINGTON, Oct. 12 (UPI) -- Institute of Medicine officials say the U.S. Department of Health and Human Services should issue health benefits regulations to ensure affordable coverage.

Mark Merritt, president and chief executive officer of the Pharmaceutical Care Management Association, said the request has sparked a long-overdue debate between employers and some powerful special interests that benefit from new mandates.

A survey showed that small employers strongly oppose many of the regulations that special interests routinely ask HHS to impose on plans that offer drug coverage -- such as restrictions on mail-service pharmacy, drugstore networks, generic drugs, pricing models and overall benefit design, Merritt said.

"On prescription drug issues, employers want access to affordable plans that promote mail-service pharmacy, offer less expensive drugstore networks, and don't require small businesses to bear the full cost of drugs that can cost $100,000 or more," Merritt said in a statement. "Some powerful special interests profit from mandates that prohibit plans from offering these options in the exchanges."

Small businesses would be among those most affected by the Essential Health Benefit rules, which apply to employers that purchase coverage and have fewer than one hundred employees, as well as qualified health plans in the state exchanges.

For example, 61 percent of small businesses said it is a good idea to "allow employers to choose lower cost plans that exclude the most expensive drugstores from their coverage network."

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