Specialists Call on Regulators to Address Challenges in Exchange Plans

The Alliance of Specialty Medicine responded to proposals outlined in a recent rule addressing Affordable Care Act (ACA) plans or Exchange plans. In their formal comments, the specialty group highlighted considerable access to care challenges facing consumers in ACA plans due to flawed network adequacy criteria that fails to account for all specialists, and particularly subspecialists. To address the problem, the Alliance urged CMS to revise its requirements so all specialists and subspecialists are considered and recommended the establishment new plan-level quality measures to incentivize robust networks. They also supported a proposal aimed at reducing consumer confusion related to medication cost-sharing, urging CMS to finalize a policy that would require plans to place all covered drugs in the appropriate cost-sharing tiers (i.e., generic drugs in the generic tier, brand drugs in the brand or specialty tiers) unless there is a clinical basis for doing otherwise. Click the link below to reach the full letter.

Alliance_2024 NBPP Proposed Rule Comments