June 03, 2015

Essential Health Benefits


States are in the process of determining the Essential Health Benefits (EHBs) that must be in their state's non-grandfathered health plans. There are several new resources to help advocates engage in the process:

 

EHBs -- Maternal and Child Health Considerations

The Association of Maternal and Child Health Programs (AMCHP) recently created a fact sheet for their members on the Essential Health Benefits (EHB) benchmark plan section process and how it might impact MCH populations and what they might do to engage in the process. The fact sheet can be found here [ignore request to sign in].

 

EHBs -- Lessons from California

The National Health Law Program has developed a one-page summary of lessons from the California EHB determination process.

 

Worth Repeating: Essential Health Benefits Rules - Prescription Drugs

In February 2015, HHS released changes to rules about Essential Health Benefits. Recent issue briefs from the National Health Law Program (NHeLP) outline current rules regarding the prescription drug benefit and identify opportunities for advocates:

Issue #1 - Formulary Transparency

Issue #2 - Exceptions Process

Forthcoming will be:
Issue #3 - Pharmacy and Therapeutics (P&T) Committees 
Issue #4 - U.S. Pharmacopeia
Issue #5 - Mail Order Pharmacies

 

Worth Repeating: EHBs -- State Refor(u)m Library

The State Refor(u)m Library has hundreds of resources about Essential Health Benefits and other ACA topics.