on Aug. 26, the Department of Health and Human Services released new guidance stating the cost-sharing rule, which would have gone into effect next year, will not be enforced. (Photo: Shutterstock)
Federal health care officials have made clear they do not believe pharmaceutical companies that provide coupons to customers are helping to make prescription drugs more affordable. However, the Trump administration hasn't quite figured out yet what to do about it.
Like insurers and pharmacy benefits managers, some of which have sought to undermine the practice with accumulator adjustment programs, the Trump administration believes such coupons may be driving up health care spending by getting patients to opt for higher-priced name-brand drugs over generics.
In a final rule published in April, the Centers for Medicare and Medicaid Services declared that insurers will be allowed to exclude coupons from counting towards a patient's annual out-of-pocket limit as long as the plan covers a generic equivalent to the drug the patient is purchasing with the coupon.
However, on Aug. 26, the Department of Health and Human Services released new guidance stating the cost-sharing rule, which would have gone into effect next year, will not be enforced. That means that insurers can continue to exclude coupons from out-of-pocket maximums even if no equivalent generic exists.
At issue was the prospect of conflicting guidance from federal agencies. On one hand, the new rule would require insurers to count coupons towards the patient's out-of-pocket limit if there was no generic version available under the plan. On the other hand, a 2004 IRS rule said that high-deductible plans must not count coupons towards a customer's deductible.
At the very least, nothing will change in the 2020 plan year. HHS says that it will provide new guidance for plans that will take effect the following year. That guidance will likely be published this fall.
In the meantime, states may take matters into their own hands, and often in ways that conflict with the desired direction of the Trump administration and the insurance industry. Three states –– Arizona, Virginia and West Virginia –– recently passed laws prohibiting accumulator adjustment programs. Others may follow suit.
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