The American Heart Association (AHA) raised concerns this month with the Alabama Department of Insurance regarding potential cuts to the number of prescription drugs covered as part of the proposed changes to their Essential Health Benefit (EHB) benchmark plan for 2020.
EHB plans include a set of 10 categories of services, like prescription drug coverage, health insurance plans must cover under the Affordable Care Act. If this proposal would have been adopted, Alabamians would have found some medications that were previously covered by their insurance plan no longer covered. Because important consumer protections are tied to EHB services, such as the annual maximum out-of-pocket limit, this would force patients to pay significantly more out-of-pocket for their care to have access to the medication they need.
Specifically, the proposed changes would have had potential to significantly harm individuals with cardiovascular diseases. As noted in the AHA letter to the Alabama Department of Insurance:
While in some cases, medications across a prescription class can be quite similar and reducing the number covered may be fine. In others, there is wide variation across the class and in how patients respond to each drug. For example, not all Beta-adrenergic Blocking Agents are shown to improve outcomes for heart failure patients. Therefore, it is critically important that plans choose to cover one that is. By cutting the number of beta blockers from 13 covered medications to 7, we are concerned heart failure patients would lose access to the medication that will work for them. The same is true for Calcium Channel Blocking Agents and Statins. Patients simply do not respond in the same way to the same medications, therefore having wide enough access to different drugs is critical to their treatment and on-going care.
The Alabama Department of Insurance responded with the following notice:
The Alabama Department of Insurance would like to thank those associations, advocacy groups and individuals who provided comments expressing their thoughts and concerns to the proposed revision to Alabama’s EHB Benchmark Plan prescription drug list for PY 2020.
Partially as a result of comments we received, the Department has elected to withdraw the EHB Benchmark Plan application with the Centers for Medicare & Medicaid Services (CMS). At this time, there will be no changes to the EHB Benchmark Plan for Alabama.
This is outstanding news and speaks to the power of public comments and the need for voices of advocacy on important issues like this. Remember, voices like yours make the difference. You're the Cure!
More background on EHB benchmark plans can be found on the CMS website.