State Exchange Benchmark Plan Choices Present New Challenges for Exchange Insurers and Pharmaceutical Companies

New Pharmspective Report Covers Implications of Benchmark Plan Selections on Access and Coverage of Pharmaceuticals

 
FOR IMMEDIATE RELEASE

NEW YORK, NY October 2, 2012 – Based on current selections by states of Exchange Benchmark Plan formularies, Pharmspective Managing Partner, Stephen Reid, projects meaningful and significant distinctions in future access and coverage of pharmaceuticals in different regions across the U.S. Pharmspective’s new research report, State Exchanges: Opportunities and Threats, highlights these distinctions.

While the September 30th deadline for states to submit their choice of State Exchange Benchmark Plan has been relaxed by HHS, preliminary submissions of Benchmark Plan selections indicate differences in access criteria across Benchmark selections. “While most therapies are available across most Exchange Benchmark Plans, some plans are more likely to have restrictive prior authorization criteria in certain therapeutic areas and a few plans will offer broader restrictions,” stated Stephen Reid, Pharmspective Managing Partner.

“HHS provided direction last year that it would only require one drug per drug class on Exchange formularies but it’s likely that most states will require Exchange insurers to adhere to comparable formularies to the Benchmark Plan. Understanding how Benchmark Plans cover therapeutic categories based on number of branded drugs covered and prior authorization criteria will be critical to determining what future Exchange formularies may look like and what manufacturers should be doing now to optimize access with insurers whose Benchmark Plans have been selected.”

Presenting on October 5th: AMCP Educational Conference

Mr. Reid, in his presentation, State Exchanges: Opportunities and Threats for Key Health Insurers, will present an overview of the potential impact of State Exchanges and Benchmark Plans on Commercial Insurers and pharmaceutical manufacturers. The session will be held on Friday, October 5th, 7:00 AM – 8:00 AM, at the AMCP Educational Conference in Cincinnati, Ohio.

He will address benchmark plan formulary selections and their impact on access and coverage of pharmaceuticals as part of a broader talk that will examine:

• The competitive market landscape facing health insurers in key battleground states where State Exchanges will likely expand coverage to large numbers of uninsured patients
• Distinctions in Benchmark Plan formularies and the implications of specific Benchmark Plan selections on broader formulary access and coverage
• The market dynamics that will advantage or disadvantage specific insurers, based on their current competitive position

Pharmspective’s new report, State Exchanges: Opportunities and Threats for Key Health Insurers/Implications for Pharmaceutical Manufacturers, addresses:

• The battleground states, where State Exchanges are likely to have the greatest impact, and insurer competitive positions and likely intentions in these states
• Opportunities and threats to market access and coverage of pharmaceuticals based on assessment of benchmark plans
• The role of MLRs in potential Payer Exchange contracting aggressiveness
• Insurer market entry strategies in ‘Clearinghouse’ states and states where federal government operation of a State Exchange is likely
• Assessment of non-profit to for-profit conversions among insurers and their impact on the market positions of insurers in key states
• Implications of contracting and product pricing with key MCOs for Pharma Managed Markets Teams

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