Health Benefits Advisor for Employers

Determining Compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) and Mental Health Parity Act (MHPA) Provisions in Part 7 of ERISA

Does the plan comply with the mental health parity provisions for multi-tiered prescription drug benefits?

• Yes
• No

There is a special rule for multi-tiered prescription drug benefits. A plan complies with the mental health parity provisions if the plan applies different levels of financial requirements to different tiers of prescription drug benefits based on reasonable factors (determined in accordance with the mental health provisions relating to nonquantitative treatment limitations discussed later in this Advisor) and without regard to whether a drug is generally prescribed for medical/surgical or mental health benefits. Reasonable factors include cost, efficacy, generic versus brand name, and mail order versus pharmacy pick-up. See 29 CFR 2590.712(c)(3)(iii).