Washington, D.C. – The American College of Rheumatology (ACR) today expressed concern that the 2019 Benefit and Payment Parameters final rule allowing states to select their own Essential Health Benefits (EHB) benchmark plans on federal health exchanges could jeopardize care access for patients with complex rheumatologic conditions.
"While we are pleased to see that the Centers for Medicare and Medicaid Services (CMS) is using this rule to reduce regulatory burdens and promote drug price transparency, we are disappointed that the agency did not heed the advice of the ACR and other health groups regarding Essential Health Benefits coverage," said David Daikh, MD, PhD, President of the ACR. "It is absolutely critical that people living with rheumatic diseases are able to access insurance coverage on the federal exchanges without having to worry about whether the treatments they need to manage their conditions will be covered."
In comments submitted last November regarding the agency's proposed rule, the ACR warned CMS that allowing states to select their own EHB benchmark plans could create a "race to the bottom" where states seek cheaper, less comprehensive coverage that limits patients access to care, and particularly access to biologic therapies. Even with CMS's agreement to include an amendment in the final rule clarifying an appropriate balance of coverage, the ACR remains concerned that allowing states to pick their own EHBs puts patients with complex needs at risk, especially in states that may allow plans to cover only one drug per class.
Separately, the ACR applauded CMS for deciding not to move forward with a proposal to designate Children's Health Insurance Program (CHIP) buy-in programs providing identical coverage to state Title XXI CHIP programs as "minimum essential coverage" without first undergoing an application process. The ACR had urged CMS to abandon this proposal as it would leave children who suffer from rheumatic diseases in a dangerous medical limbo with no guarantee that coverage provided under these programs would be the same.
"We remain committed to ensuring that all rheumatic disease patients are able to access high quality, affordable care and will continue to serve as a resource for CMS as it works to extend coverage, reduce barriers, and expand patient choice," Dr. Daikh continued.
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About the American College of Rheumatology
The American College of Rheumatology (ACR) is the nation's leading advocacy organization for the rheumatology care community, representing more than 6,400 U.S. rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.
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