Maryland Commission Removes Requirement for Small Business Benefits Packages To Cover Brand-Name Prescription Drugs

The Maryland Health Care Commission on Tuesday approved a plan to remove most prescription drug coverage from the required-benefits package for small companies that offer group health insurance, "with the expectation" that most employers will offer additional drug benefits, the Baltimore Sun reports. According to the Sun, 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. 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, adding that he thinks few will reduce benefits under the new requirements. Cowdry 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.

However, Constance Row, the only commission member to vote against the revision, said, "It will leave employers with an option of offering only (coverage for) generics with a high deductible, and I expect we will see a fair number of employers choosing that option."

Gail Wilensky, MHCC vice chair, 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" (Salganik, Baltimore Sun, 11/23).