In formal comments to the Centers for Medicare and Medicaid Services (CMS), the Alliance of Specialty Medicine registered its concerns with the agency’s intent to establish a national benchmark plan standard for prescription drugs. “A national benchmark could lead to greater federalization and, as a result, less provider and patient choice and access to life-saving medications,” the specialty physicians explained. “This is particularly true because, in the experience of our members, formulary decisions too often can be influenced by financial considerations rather than clinical data.” The Alliance also expressed longstanding concerns with CMS’ reliance on states and accrediting organizations to assess network adequacy. They note states are not prepared to carry ensure network adequacy and accrediting organizations cannot hold insurers liable if and when consumers cannot access the specialty medical care they require. 

 

Click here to read the letter.