Federal Government Retreats From Finalized Policy; Will Allow Broader Use of Co-Pay Accumulator Programs for 2020 Plan Year


On August 26, 2019, the Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) jointly announced that they will not enforce HHS’s recently finalized policy that limits private health plans’ use of accumulator programs — i.e., programs that exclude the value of direct manufacturer cost-sharing support (such as co-pay coupons) from patients’ annual cost-sharing limits — to prescription brand drugs for which a medically appropriate generic equivalent is available.

The Departments concluded that the policy conflicts with existing Internal Revenue Service (IRS) guidance that requires high-deductible health plans (HDHPs) to exclude all drug and manufacturer discounts when calculating patient contributions toward plan deductibles. The Departments will address this conflict by permitting health plans to use accumulator programs and exclude the value of manufacturer coupons from annual cost-sharing limits — regardless of whether medically appropriate generic equivalents are available — until a revised policy is issued for the 2021 plan year.

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