HHS Walks the Middle Ground in Final Ruling on Nondiscrimination Drug Access and Formulary Construction Still Unguided

摘要

New federal standards aimed at preventing discrimination in all fed-I eral health plans and programs1 disappointed patient advocacy groups that had hoped for requirements dictating expansive formularies. They wanted the Department of Health and Human Services (HHS) to instruct Medicare, Med-icaid, marketplace and community health plans, and others receiving federal funds that certain formulary restrictions, such as placing expensive drugs on the highest tiers, were discriminatory. But the HHS declined to adopt such standards. That was a victory for insurance companies and their pharmacy benefit managers. But neither did the HHS establish a "safe harbor" where drug benefit access practices approved by P&T committees would be deemed compliant with the new antidiscrimination standards.