Agencies Jointly Clarify Interim Guidance on Copay Accumulators

Dave Borden, Chief Executive Officer
August 27, 2019

In an FAQ issued jointly by the Department of Labor (DOL), Health and Human Services (HHS), and the Treasury on August 26, the agencies acknowledge that ambiguity in the language of the HHS 2020 NBPP Final Rule has created confusion regarding how to apply drug manufacturers’ coupons toward health plan enrollees’ annual limitation on cost sharing. The FAQ also notes that complying with the rule could create a conflict with IRS rules for minimum deductibles for HDHPs.

HHS will remedy the conflict in its forthcoming HHS Notice of Benefit and Payment Parameters for 2021, developed in consultation with DOL and Treasury. In the meantime, all three agencies agree not to enforce any actions for noncompliance and allow for states to refrain from enforcing, as well.

You can count on PSG to continue to monitor developments as guidance on this issue continues to unfold in the coming months.


Direction regarding copay accumulators continues to evolve. We originally provided a detailed look at the issue in our PSG Position here


Dave Borden has more than 27 years of experience in the health care and pharmacy benefits industry, working primarily with large self-insured employers. He has provided consulting services to some of the largest plan sponsors in the country. A representative list of clients Dave has served includes Exelon Corporation, Sara Lee Corporation, ConocoPhillips, SBC, Blockbuster, Baylor Healthcare System, Tenet Hospitals, Christus Health, Catholic Health Partners, Carolinas Healthcare System, USAA, ACCOR, Wyndham International, and a variety of other nationally recognized employers.