February 26, 2013

Final Rule on Essential Health Benefits: A Brief Summary of Key Issues That Affect Access to Medicine

Arnold & Porter Advisory

On February 20, 2013, the Centers for Medicare and Medicaid Services (CMS) released its final rule on standards related to essential health benefits (EHBs), actuarial value, and accreditation. This summary outlines the key issues addressed in the rule that will affect access to medicines starting in 2014. Specifically, we discuss briefly CMS' general approach to EHB; how CMS will apply that approach to prescription drugs; patient cost-sharing; and CMS' standards for determining a plan's actuarial value.


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