We finalized a maximum annual limitation on cost sharing of $8,150 for self-only coverage and $16,300 for other than self-only coverage for the 2020 benefit year. This represents an approximately 3.16 percent increase above the 2019 parameters of $7,900 for self-only coverage and $15,800 for other than self-only coverage.

(N.B. High deductible plans associated with health savings accounts are further subject to an IRS out of pocket maximum notice that is issued in May.), and

Beginning in 2020, we will allow individual market, small group, large group and self insured group health plans to except from the maximum out-of-pocket limit cost sharing amounts paid using drug manufacturer coupons for specific prescription brand drugs that have an available and medically appropriate generic equivalent. 

The drug manufacturers are flipping out over this change which equitably limits double dipping by consumers (once from the manufacturer and once from the health plan).

Forbes reports that UnitedHealth Group and Anthem are each interested in acquiring Magellan.  “Magellan is known for its behavioral health services though it also has a pharmacy benefit management (PBM) business and Medicaid health plans.”

The Department of Health and Human Services released electronic health record interoperability news today. HHS is delaying until June 2 (30 days) the comment deadline on its two pending proposed interoperability rules. HHS also issued for public comment

draft 2 of the Trusted Exchange Framework and Common Agreement (TEFCA) that will support the full, network-to-network exchange of health information nationally. HHS also released a notice of funding opportunity to engage a non-profit, industry-based organization that will advance nationwide interoperability.

EHR Intelligence tells us about a government data sheet that explains how hospital use electronic health records to improve the quality of care.

MedPage Today brings us up to date on Congressional efforts to regulate health plan prior authorization requirements. The article adds that

In March, the eHealth Initiative, a coalition of provider and healthcare industry organizations, issued a paper on “Considerations for Improving Prior Authorization in Healthcare.” The document included four central points:

• Transparency of payer policy and evidence-based clinical guidelines available at the point of care may, in many cases, reduce the need for prior authorization and minimize care delays.
• Reducing the overall volume of services and drugs requiring prior authorization could decrease administrative burdens and costs for all stakeholders.
• Payers, healthcare professionals, and vendors should use existing, industry-endorsed standards whenever possible and explore incorporating new electronic standards that have the capability to improve the prior authorization process.
• Payers and healthcare professionals should explore alternative payment models that promote bundled authorization for procedures, medications, and durable medical equipment that are associated with a particular episode of care.