Anthem Details Compliance Plan for Gag Clauses Provision Attestation

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Anthem has detailed its plans and commitments in response to the gag clauses provision, which bars group health plans and health insurance issuers from entering into any agreement that would restrict the disclosure or access of price and quality information. As a part of this compliance, Anthem will undertake the annual attestation on behalf of fully insured, Anthem Balanced Funding, and MEWA groups.

For groups that have third-party or carveout vendors requiring attestation, such as carveout PBMs, Anthem has recommended that they work with their vendors directly. Instructions for completing this attestation can be found at the CMS link provided by Anthem: CMS Gag Clause Prohibition Compliance

For ASO groups, Anthem is providing confirmation of compliance, enabling these groups to complete the attestation on the CMS HIOS portal. The attestation statement applies strictly to the business and data that Anthem administers and maintains.

For the 2023 attestation requirement, Anthem will submit the attestation on behalf of ASO clients upon request. Anthem will conduct a survey with ASO groups; those desiring Anthem to submit the attestation on their behalf must provide the required data by the survey's due date. If no survey response is received, Anthem will assume that the client will complete their attestation.

Anthem has clarified that it will only attest for the business and data it administers and maintains, and will not include attestation for third-party vendors. If a group has pharmacy coverage through CarelonRx integrated with their Anthem plan, Anthem will include the pharmacy coverage as a part of their attestation.

Finally, Anthem confirmed that their provider contract templates do not contain language restricting the disclosure of cost information, though there are some negotiated contracts that do. Anthem is currently evaluating these restrictions and has reminded its providers about the CAA provision on gag clauses and the obligation to comply with the law.