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Rheumatologists, Providers & Patients Seek Improvements in Exchange Plan Policy Proposals
Last year, the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) issued its 2025 Notice of Benefit and Payment Parameters (NBPP), which proposed changes to plans established by the Affordable Care Act (ACA), commonly referred to as Exchange or Marketplace plans. Some of the proposed changes addressed network adequacy, the provision of essential health benefits (EHBs), prescription drug benefits, and non-standardized plan options, among other things.
CSRO, independently and as part of the Alliance of Specialty Medicine (ASM) and the All Co-pays Count Coalition (ACCC), urged the Agency to better protect access to specialty drugs for consumers in Exchange plans, highlighting emerging challenges with “alternative funding” practices that may diminish access. All three groups also urge the Agency to provide enhanced oversight when it comes to non-standardized plan options in the health insurance marketplace based on concerns that such options might further hinder access to care for those with chronic and high-cost conditions, and to ensure specialty and subspecialty providers are able to join and remain in Exchange plan networks. Read more our letters linked below.
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