Arthritis Foundation Legislative Position Statements

Arthritis Foundation Position Statement on Health Insurance Plan Formulary Transparency

Issue

Most health insurance plans have a website that allows consumers to compare costs and benefits as they shop for the best health care coverage. However, these websites generally do not include specific information on issues of importance for people with arthritis, such as cost sharing, prior authorization or step therapy requirements regarding specific medications.

Background

Transparency in insurance health plans would benefit people with arthritis who are comparing the provisions and benefits of various insurance plans. Formulary transparency gives consumers essential care information on specific drug coverage, out of pocket costs, coverage limits, prior authorization requirements and step therapy protocols.

People with substantial prescription drug needs – especially those living with chronic conditions such as rheumatoid arthritis – must be able to access this information so they can select the most fitting health insurance plan. Formulary transparency makes it easier for those with serious conditions to choose a plan that will cover the prescription drugs and therapies they need.

Arthritis Foundation Position

The Arthritis Foundation supports legislation that provides formulary transparency in health insurance plans and should require the following:

  • Maintain a clear searchable listing of medications covered in a plan’s formulary by drug name and disease type.
  • Disclose all co-payment and co-insurance obligations for each medication.
  • Disclose special requirements for each medication, including step therapy and prior authorization.
  • Disclose formulary changes on a monthly basis and within 72 hours during open enrollment.
  • Provide alternative methods for reviewing formulary listing to those without internet access.

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