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Prescription Drug Rule Implementation Delayed

The U.S. Department of Labor, Health and Human Services (HHS) and Treasury delayed the implementation of the HHS 2020 Notice of Benefit and Payment Parameters until Jan. 1, 2021, or later. The federal rule would require health insurance plans to credit to the out-of-pocket maximum the amount of financial assistance received from drug manufacturers.

Large group health insurance issuers and self-insured group health plans have been using manufacturer drug coupons to help plan members get lower or no cost brand-name drugs. These coupon programs, known as "copay assistance programs," typically apply to high-cost specialty drugs for which a generic is not available.

Confusion arose over whether the HHS rule requires plans to count the value of drug manufacturers' coupons toward the patient's out-of-pocket maximum.

Additionally, the departments issued an FAQ in 2014 stating that non-grandfathered health plans in the individual and small group markets must provide coverage of essential health benefits and that other requirements apply.

The 2021 HHS Notice of Benefit and Payment Parameters will address these issues in more detail.

Therefore, until the 2021 Notice is issued, the Departments will not initiate enforcement action if a group health plan excludes the value of drug manufacturers' coupons from the annual limit on cost sharing.

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In this issue:

Prescription Drug Rule Implementation Delayed

Basic Steps to Avoid Discrimination in the Workplace

Key Elements of a Good Health Benefit Plan for Small Companies

Ways to Make Saving Easier for Your Employees

Employees Need to Know About 401(k) Required Minimum Distributions

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