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EHB Prescription Drug Standard: United States Pharmacopeia Classification System (PDF)
National Health Law Program [NHeLP]Link to more items from this source
[Guidance Overview]
July 29, 2015
"In the Essential Health Benefits Final Rule from February 2013 (Final Rule 2013), HHS chose the USP Medicare Model Guidelines classification system (version 5.0) as the comparison tool to determine EHB prescription drug coverage.... [H]ealth plans must cover at least the greater of [1] one drug in every USP therapeutic category and class or [2] the same number of drugs in each USP category and class as the state's EHB base-benchmark plan.... The Final Rule 2016 adopts an approach that combines: [1] the use of a [Pharmacy and Therapeutic (P&T)] committee and [2] the existing USP standard. This change will go into effect beginning with plan years on or after January 1, 2017."

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