PCMA urges CMS to keep coverage affordable, flexible

02/8/2013 | AIS Health

CMS should permit payers to "determine the number of drugs to be covered within the benchmark plan's classification system based on clinical evidence and treatment effectiveness," the Essential Health Benefits Coalition said at a recent news briefing. "Benefits must not only be comprehensive, but also cost-effective, and plan sponsors really need the flexibility to be able to design clinically based formularies and negotiate bigger price concessions from drugmakers," said Charles Coté, PCMA's assistant vice president for strategic communications. "HHS should continue to focus on whether plans are covering the right kinds of drugs to treat relevant medical conditions, not just focusing on the number of drugs covered."

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