The White House Office of Management and Budget (OMB) is conducting a final review of the essential health benefit (EHB) regulations under the Affordable Care Act (ACA). Under the ACA, health plans in state health insurance exchanges must provide coverage for 10 broad categories of benefits, such as maternity care, prescription drugs and preventive care. HHS in November 2012 released a proposed rule on the minimum benefits.
OMB is launching its review of the proposed essential health benefits rule, which would take effect next January, after receiving more than 3,500 public comments. One of the essential benefits rule’s major issues addresses prescription drug coverage. The rule requires that health plans cover at least one drug in every category and class, or the same number of drugs in each category and class as the state’s benchmark plan, whichever is more generous. Patient advocacy groups have urged CMS to expand access to a wide range of prescription drugs, while a number of employer groups have argued that the rule would drive up costs, making insurance unaffordable for individuals and small businesses.