THE ‘NO-COST’ QUESTION — HHS and other agencies are culling through feedback they requested on whether health plans should be required to cover over-the-counter preventive items at no out-of-pocket cost without a prescription for the OTC product. Such a move by HHS and the Treasury and Labor departments would transform the way consumers could access birth control, smoking cessation items and other products. The Biden administration hopes it could be a boon for health equity and fighting systemic racism. Insurers and the pharmacy benefit managers that negotiate prescription drug costs broadly support their goal of ensuring affordable access to OTC preventive products for consumers — but urge caution. With a comment period that closed Monday, insurers, employee benefits groups and PBMs want guardrails against overuse and fraud, including purchases made by ineligible persons or those buying products to resell. The ERISA Industry Committee, which represents large employers' benefit interests, warned that if not properly implemented, such a plan could cause premiums and costs to rise. “Such overuse and misuse will contribute to increased health care spending, and such increased health care spending will ultimately be borne by the plan sponsor and its participants in the form of higher premiums,” ERIC wrote. Some suggestions from insurers, PBMs and other groups included: Requiring prescriptions: The Alliance of Community Health Plans and alternative PBM Navitus Health Solutions called for prescriptions to be required. ACHP said the setup would allow claims to be processed at the counter and could help avert safety issues, and Navitus argued it could help curb overuse and costs. Other groups like the insurer lobby AHIP called for a “phased approach” to no-cost coverage of OTC products without a prescription, beginning with contraception. Covering in-network: Insurers and a top PBM lobbying group, the Pharmaceutical Care Management Association, said if in-network providers are available, plans shouldn’t have to cover services out of network. Without such a requirement, AHIP argued, some retailers and manufacturers could hike prices. Addressing practical challenges: To expand access, AHIP called for a wide variety of options for consumers, including a “debit card-like” method, online purchasing and post-purchase reimbursement. Navitus said no systems are in place to deal with reimbursement and called on the agencies to allow “flexibility and time” to develop ways of implementing a potential mandate. ERIC called for the agencies to “clearly categorize” eligible items in a list. WELCOME TO WEDNESDAY PULSE. Nearly half of Americans say they would be open to buying prescription drugs from a non-FDA-approved source online if they couldn’t otherwise get it, according to a new ASOP Global Foundation-commissioned survey. Reach us at bleonard@politico.com or ccirruzzo@politico.com. Follow along @_BenLeonard_ and @ChelseaCirruzzo. TODAY ON OUR PULSE CHECK PODCAST, host Lauren Gardner talks with POLITICO health care reporter Ruth Reader, who explains why legislators are worried that tech companies like Google are too quickly deploying artificial intelligence in health care products and services before regulations protecting patients are set.
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