Commission Approves Removal of Rx Coverage for Small Cos.

November 28, 2005 ( - The Maryland Health Care Commission approved a plan to remove most prescription drug coverage from the required-benefits package for small companies that offer group health insurance.

The Baltimore Sun reports that the Commission approved the plan “with the expectation” that most employers will offer additional drug benefits. The modifications will go into effect July 1, 2006, and apply to employers with as many as 50 workers if they offer group health coverage.

The new standard benefits package will not include coverage for brand-name drugs, according to the Sun. Employees of affected small businesses also will have to pay deductibles of $2,500 for individuals and $5,000 for families before generics will be covered.

Rex Cowdry, executive director of the health commission, said about 90% of the 50,000 participating employers already offer coverage beyond the standard and he thinks few will reduce benefits under the new requirements. He said that the reduced requirements will enable insurers to create more pharmacy benefit plans at lower prices, which might encourage more employers to purchase group insurance.

Gail Wilensky, vice chair of the commission, said a majority of small employers do not offer health benefits at all, adding, “What we want to do is give employers an option [of] going to that minimum.”