Brand-New Atlantic Information Services Report Outlines Exchange Regulations Governing Pharmacy Benefits
Atlantic Information Services, Inc. (AIS) - June 28, 2013 - Washington, DC

Industry-leading health business information publisher Atlantic Information Services is pleased to announce the release of Designing Pharmacy Benefits in Health Insurance Exchanges. The book, the first in AIS’s Management Insight Series, outlines the health insurance exchange regulations governing pharmacy benefits, and offers strategies for maximizing the value of the pharmacy benefit while still complying with state and federal rules.

Of the 10 essential health benefits that must be included in small-group and individual products sold on health insurance exchanges in 2014, the rules governing prescription drugs have changed the most since HHS’s initial guidance. Health plans must create a more substantial pharmacy benefit than initially expected, which could impact their ability to contain costs.

Providing straightforward advice presented in an easy-to-follow question-and-answer format, Designing Pharmacy Benefits in Health Insurance Exchanges is intended to help pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at health plans, PBMs and pharmacy benefit administrators, pharmaceutical manufacturers and consulting firms get to the bottom of key issues such as mid-year formulary changes and how specialty drugs might be treated under the regulations. And relevant regulations and bulletins offer the tools necessary to make sure pharmacy benefit design complies with state and federal exchange requirements while balancing cost with access.

Designing Pharmacy Benefits in Health Insurance Exchanges includes material adapted from a December 2012 AIS webinar presented by John Jones, Senior Vice President, Professional Practice and Pharmacy Policy at OptumRx, a UnitedHealth Group Company, and Caroline Pearson, Vice President of Avalere Health LLC, as well as appendices of essential health benefits data.

For more information on Designing Pharmacy Benefits in Health Insurance Exchanges, including a full table of contents and a PDF of the foreword to the report, visit

AIS’s Management Insight Series is designed to provide practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers. See a full list of titles in this series at

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

Jill Brown, Executive Editor
Atlantic Information Services, Inc.
202-775-9008 ext. 3058

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