Date: June 25, 2003 Afternoon Session
Title: Mandated Benefits
A number of states have long mandated coverage of a variety of health care services, including certain pharmaceuticals. How prevalent are these mandates? Which benefits are most and least widely mandated? What are the effects of these mandates? To what extent do these mandates increase the cost of health insurance coverage? To what extent would these benefits be available in the private coverage market, absent the mandate? For example, are these benefits typically provided by self-funded employee benefit plans, which are not subject to these mandates? What factors explain why certain states choose to mandate certain benefits?
Date: June 26, 2003 Morning Session
Title: Pharmaceuticals: Formulary Issues
Pharmacy benefit managers (PBMs) have emerged as major factors in the marketing and distribution of pharmaceuticals. How do PBMs work? What information do PBMs disseminate about their operations? What factors enter into PBM formulary listing decisions and how transparent are those decisions? What tools do PBMs employ, and how effective are these tools? What are the effects of PBMs on the cost of pharmaceuticals? What state and federal laws affect how PBMs operate? What, if any, are the barriers to entry for potential competitors to existing PBMs? What consumer information, consumer protection, and antitrust issues are raised by the presence of PBMs in the market?
Date: June 26, 2003, Afternoon Session
Title: Prospective Guidance
To provide prospective guidance to requesting parties and to the public, the FTC provides advisory opinions and the DOJ provides business review letters. Over the past decade, the FTC and DOJ have each generated approximately a half dozen such opinions and letters relating to health care per year. Does this modest volume reflect the true demand for prospective guidance, or are parties discouraged from obtaining advisory opinions and business review letters? Is prospective guidance helpful or unhelpful in the health care context? Is prospective guidance too costly or too slow? What changes would make prospective guidance more useful? How does the prospective guidance provided by the FTC and DOJ compare to that provided by other federal agencies?