on Aug. 26, the Department of Health and HumanServices released new guidance stating the cost-sharing rule, whichwould have gone into effect next year, will not be enforced.(Photo: Shutterstock)

Federal health care officials have made clear they do notbelieve pharmaceutical companies that provide coupons to customersare helping to make prescription drugs more affordable. However,the Trump administration hasn't quite figured out yet what to doabout it.

Like insurers and pharmacy benefits managers, some of which havesought to undermine the practice with accumulator adjustment programs, the Trumpadministration believes such coupons may be driving up health carespending by getting patients to opt for higher-priced name-brand drugs over generics.

Related: Copay accumulator programs leave consumers on thehook for high drug costs

In a final rule published in April, the Centers for Medicare andMedicaid Services declared that insurers will be allowed to excludecoupons from counting towards a patient's annual out-of-pocketlimit as long as the plan covers a generic equivalent to the drugthe patient is purchasing with the coupon.

However, on Aug. 26, the Department of Health and Human Servicesreleased new guidance stating the cost-sharing rule, which wouldhave gone into effect next year, will not be enforced. That meansthat insurers can continue to exclude coupons from out-of-pocketmaximums even if no equivalent generic exists.

At issue was the prospect of conflicting guidance from federalagencies. On one hand, the new rule would require insurers to countcoupons towards the patient's out-of-pocket limit if there was nogeneric version available under the plan. On the other hand, a 2004IRS rule said that high-deductible plans must not count couponstowards 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 takeeffect the following year. That guidance will likely be publishedthis fall.

In the meantime, states may take matters into their own hands,and often in ways that conflict with the desired direction of theTrump administration and the insurance industry. Three states ––Arizona, Virginia and West Virginia –– recently passed lawsprohibiting accumulator adjustment programs. Others may followsuit.

Read more: 

• Pfizer settles copay-assistance kickback case for$24M
• Study quantifies skyrocketing copays for theinsured
• Drugmakers back copay limits