OBJECTIVES: Since last year the Affordable Care Act requires new health plans to cover essential health benefits (EHB), including pharmaceutical products, according to the state level benchmark plans. The objectives of this analysis were to understand state level variations in design of plans, access to drugs and likely impact on patient choice and health outcomes. METHODS: Benchmark plans for the top five states (i.e., FL, IL, NY, TX and CA), covering ~116 million lives, were obtained from the CMS. For each plan, the categories, classes and number of covered drugs was collected and pooled into one database. Analysis was conducted at the entire population level, state-level and for top classes of drugs. The comments from patient groups were reviewed to understand the impact of EHB on patient choice and health outcomes. RESULTS: Benchmark plans for the top five states provide coverage of 4215 drugs belonging to 158 classes as defined by USP. While four states (FL, IL, NY and TX) had a similar number of covered drugs (median of 892 drugs), CA had a significantly lower number of covered drugs, amounting to 28% less than the other four states. On average, 10% of the drugs were in the class called “No USP Class”, highlighting the limitation of CMS designated USP classification system for the new plans. In CA, FL, IL, NY and TX there were 18, 7, 8, 11 and 8 classes, respectively, for which only 1 was covered. In CA, top 8 classes were identified for which patients had a 75% lower choice than other states, and these included indications such as Anti-Diabetics and Pain medications. CONCLUSIONS: Review of new benchmark plans shows some states can have a significantly lower patient choice of therapies. There is a need for new policy measures to ensure that all patients have equal access to new treatments.