Insurers may have to include more drug coverage info on benefits summaries

Insurers might have to provide consumers with more information about their drug coverage if federal regulators include recommendations from doctors and pharmaceutical companies in the next revision of the summary of benefits and coverage (SBC) as well as the uniform glossary, LifeHealthPro reported.

The American Medical Association (AMA) and the Pharmaceutical Research and Manufacturers of America (PhRMA) want to make certain changes to the SBC that would help consumers determine whether plans cover the drugs they take.

Those changes include requiring insurers to state whether their plans' out-of-pocket cost limits include a member's prescription drug costs and link the prescription drug information to a website that lets consumers search for specific drugs in the insurer's formulary. Plus, the AMA and PhRMA want regulators to change the definition of "specialty drug" to make it clear the drug is actually in a special category within the insurer's drug tiers.

The Blue Cross Blue Shield Association said it wants the SBCs to be easier for consumers to understand, while America's Health Insurance Plans (AHIP) wants the SBC to not be too associated with the two-tiered, in-network and out-of-network plans that currently dominate the insurance market, LifeHealthPro noted.

AHIP also said regulators should conduct more consumer testing, including more information about how they actually shop for health plans and whether they really use the SBC to determine which plan to buy.

Meanwhile, some insurers, acting as part of a new campaign called Clear Choices, are pushing for more transparency on health insurance exchanges, including requiring the marketplaces to provide information about online prescription drug formularies and clearer summaries of benefits, FierceHealthPayer previously reported.

Federal regulators were hoping to have an updated SBC by 2016. But many insurers needed more time to test consumer matierials, so the updated SBC won't be available until 2017, noted LifeHealthPro

To learn more:
- read the LifeHealthPro article