Radar on Drug Benefits

Proposed Regs Tweak Rx Drug Coverage in Exchanges, MA

  • Nov 22
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    Nov 22, 2023

    Deep within two new proposed health insurance regulations are provisions that would alter how Medicare Advantage and Affordable Care Act exchanges cover prescription drugs — and some of them are garnering praise from patient advocates.

    For example, the HIV+Hepatitis Policy Institute welcomed two of the proposals in the 2025 Notice of Benefit and Payment Parameters (NBPP), the annual regulation governing the ACA marketplaces, which CMS released on Nov. 15.

    One of those provisions would codify existing policies surrounding how health plans treat prescription drugs that aren’t part of a given state’s essential health benefits (EHB) benchmark plan. Under the ACA, individual market plans must cover items and services in 10 core benefit categories, including prescription drugs, and each state is responsible for defining which drugs make the must-cover list.

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    • Leslie Small

    Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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Meet Our Reporters

Lauren Flynn Kelly

Executive Editor, AIS Health, and Managing Editor, Radar on Medicare Advantage

View Lauren Flynn Kelly's Profile

Angela Maas

Managing Editor, Radar on Specialty Pharmacy and Spotlight on Market Access

View Angela Maas's Profile

Leslie Small

Managing Editor, Health Plan Weekly and Radar on Drug Benefits

View Leslie Small's Profile

Tim Casey

Reporter, Health Plan Weekly and Radar on Drug Benefits

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Carina Belles

Reporter, Radar on Medicare Advantage and Spotlight on Market Access

View Carina Belles's Profile

Jinghong Chen

Reporter, Health Plan Weekly and Radar on Drug Benefits

View Jinghong Chen's Profile

Jill Drachenberg

Reporter, Health Plan Weekly and Radar on Drug Benefits

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ACA Exchanges
Medicare Part D
Medicare Advantage Rx drug
Benefit Design
Legislation & Regulation
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