Study: Drug benefits already exceed new federal standards

{mosads}Under HHS’s approach, states will choose an existing healthcare plan, and that policy’s benefits will become the “benchmark” for what’s considered an essential benefit in the state. Avalere analyzed existing plans that could be used as benchmarks and found that their drug coverage is usually rather generous.

Policies offered to small businesses typically cover about 70 percent of the drugs available for a particular condition, according to Avalere. Large plans offered to federal employees, which can also be used as a benchmark, cover every drug approved by the Food and Drug Administration.

HHS’s standards only require benchmark plans to cover one drug in a particular class.

The findings show that plans will still have plenty of flexibility to change their drug benefits without running afoul of federal law, Avalere said. That’s been a key concern for the insurance industry, which has said overly prescriptive rules on essential benefits would make it difficult to offer lower-cost policies.