25 Oct Prescription Drug Coverage: New Recommendations from the National Association of Insurance Commissioners
As someone dealing with cancer, you are probably no stranger to the exorbitant costs of prescription drugs. In fact, the cost of all drugs, not just cancer drugs, has received quite a bit of news coverage lately. Everyone admits there is a problem, but very few have identified any solutions. Now, the National Association of Insurance Commissioners (NAIC) has done just that. At the NAIC’s summer meeting in August, a report was issued with a list of recommendations for state and federal policymakers to improve access to affordable prescription drugs.
- Limit consumer out-of-pocket costs, by, for instance, prohibiting co-insurance for prescription drugs
- Prohibit insurance companies from changing their formulary mid-year, if it negatively affects enrollee access to drugs
- Limit the number of drug tiers that insurers can use
- Require formularies to be updated weekly and include information about drug tiering, the actual dollar amount of any cost-sharing, any utilization management or network restrictions, and the process to request a drug exception, among other information
- Adopt standardized plans with meaningful cost-sharing limits to lessen the effects when an insurance company uses drug tiers
- Collect standardized, plan-level data to enable the development of consumer tools and apps
- Solicit feedback from external stakeholders—such as advocates, other state agencies, ombudsmen, and independent medical experts—to inform the formulary review process.
Frustratingly, these recommendations won’t translate into meaningful change for quite some time. Still, without consumer advocates starting the conversation about reform, change would never happen.