Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
When consumers enroll in a health insurance plan, they gain access to a network of medical providers. This network must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. While network adequacy is not a new concept, it has a new urgency in light of the sheer number of newly insured Georgians enrolled in individual plans; the move on the part of insurance companies toward narrow networks and tiered networks, which limit the number of providers plan enrollees can access; new federal standards; and a new model act from the National Association of Insurance Commissioners (NAIC) that provides updated guidance for states. Georgia health care consumers need and deserve clear standards and protections that ensure their coverage translates to access to care without financial hardship. Georgians for a Healthy Future released today at a public policy form held in Atlanta a new policy brief on network adequacy. This policy brief:
– explains the importance of network adequacy for access to care
– outlines current network adequacy standards in Georgia
– summarizes recent policy activity around network adequacy
– sets forth consumer-oriented principles for network adequacy standards in Georgia
– provides policy recommendations to achieve network adequacy in Georgia.