Agencies Jointly Clarify Interim Guidance on Copay Accumulators


August 29, 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.

PSG will continue to monitor and report on 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