CMS Codifies EHB Drug Standards But Punts On Large Group, Self-Insured Plans; Requires Patient Reps On P&T Panels

By Luke Zarzecki / April 2, 2024 at 7:24 PM
CMS put minimum membership standards for patient representatives on Pharmacy and Therapeutic Committees and codified its current essential health benefit prescription drug policy in the final 2025 exchange rule out Tuesday (April 2). But the administration put off for future rulemaking application of the EHB policy to large group market health plans and self-insured group health plans. The final exchange codifies CMS’ current EHB policy -- if a plan covers prescription drugs in addition to those covered by a state’s...

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