(Photo: Shutterstock)
When CMS issued its Final Rule for the 2020 Annual Notice of Benefit and Payment Parameters, it included language designed "to encourage enrollees' use of lower-cost generic drugs."
Specifically, CMS stated that "beginning in 2020, we will allow individual market, small group, large group and self-insured group health plans to except from the maximum out-of-pocket limit cost sharing amounts paid using drug manufacturer coupons for specific prescription brand drugs that have an available and medically appropriate generic equivalent."
This well-intentioned release has triggered an avalanche of confusion and conflicting commentary throughout the industry, spanning the entire spectrum from question on what "specific prescription drugs" means (will CMS be releasing some sort of list of drugs?), to what other types of manufacturer/third party assistance, if any, could be included given the specific reference only to "coupons," to whether this guidance has any impact on situations in which there is not a "medically appropriate generic equivalent" available.
Continue Reading for Free
Register and gain access to:
- Breaking benefits news and analysis, on-site and via our newsletters and custom alerts
- Educational webcasts, white papers, and ebooks from industry thought leaders
- Critical converage of the property casualty insurance and financial advisory markets on our other ALM sites, PropertyCasualty360 and ThinkAdvisor
Already have an account? Sign In Now
© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.