As states establish health insurance exchanges, insurers are making benefit design and formulary decisions that will impact product coverage. Pharmaceutical, biotechnology, and medical device manufacturers face the potential to reach approximately 25 million new patients. However, federal rules will also present patient access challenges.
Open enrollment for qualified plans offered through state health insurance exchanges —marketplaces for health insurance coverage — begins in October 2013 for the following plan year beginning January 01, 2014.
In anticipation of the potential positive and/or negative impact of exchange products on the pharmaceutical, biotechnology, and medical device industries, Global Integrated Reimbursement Services, Inc. (GIRS) is well-positioned to:
- Assist your company in understanding projected enrollment and benefit designs for plans offered through health insurance exchanges and the impact on patient access to drugs, medical devices, and various services; and
- Assess opportunities and risks for your product portfolio centered on probable cost-sharing structures, utilization management controls, and limited network utilization in exchange plans.