The American College of Rheumatology (ACR) has expressed concern over the 2019 Benefit and Payment Parameters final rule allowing states to select their Essential Health Benefits benchmark plans on federal health exchanges. The agency notes that the final rule could limit access to care for patients with complex rheumatologic conditions.
The ACR has previously warned the US Centers for Medicare and Medicaid Services (CMS) that allowing states to select their own Essential Health Benefits benchmark could encourage them to seek cheaper, less comprehensive coverage that could create barriers to care, and could limit access to biologic therapies.
“While we are pleased to see that the [CMS] is using this rule to reduce regulatory burdens and promote drug price transparency, we are disappointed that the agency did not heed the advice of the ACR and other health groups regarding Essential Health Benefits coverage,” stated David Daikh, MD, PhD, current president of the ACR. “It is absolutely critical that people living with rheumatic diseases are able to access insurance coverage on the federal exchanges without having to worry about whether the treatments they need to manage their conditions will be covered.”
Although the CMS agreed to include an amendment in the final rule clarifying an appropriate balance of coverage, the ACR notes that allowing states to pick their own Essential Health Benefits will put patients with complex conditions at risk, particularly if states allow plans to cover only one drug per class.
However, the ACR supports CMS’s decision not to move forward with a proposal to designate Children’s Health Insurance Program (CHIP) buy-in programs providing identical coverage to state Title XXI CHIP programs as “minimum essential coverage” without undergoing an application process. The ACR noted that this proposal would leave children with rheumatic diseases with no guarantee that coverage under these programs would be the same.
“We remain committed to ensuring that all rheumatic disease patients are able to access high quality, affordable care and will continue to serve as a resource for CMS as it works to extend coverage, reduce barriers, and expand patient choice,” Dr Daikh concluded.
ACR Responds to HHS Benefit and Payment Parameters Final Rule [press release]. Atlanta, Georgia: American College of Rheumatology. https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/884/ACR-Responds-to-HHS-Benefit-and-Payment-Parameters-Final-Rule. Published April 12, 2018. Accessed April 12, 2018.