Insurers To Be Allowed To Prevent Drug Coupons From Applying To Annual Limit On Out-Of-Pocket Costs In Some Cases
CMS will allow insurers to implement the restrictions when there's a generic drug available to the patient. CMS argues that the rule would encourage patients to use generic drugs and lower drug spending.
CMS To Allow Copay Accumulators, Cut Exchange User Fees
The CMS finalized a rule on Thursday that would allow health insurers to implement copay accumulator programs to prevent drug manufacturer coupons from applying to a patient's annual limit on out-of-pocket costs in situations where a generic drug is available. Last month, Virginia and West Virginia became the first states to ban such programs on the individual market. Another eight states are considering passing their own laws to ban copay accumulators, which patient advocates say limits access to medication. (Livingston, 4/18)
In other news from CMS —
CMS Proposes Small Boost To Inpatient Rehab Facility Payments
The CMS is proposing to raise the estimated payments per discharge for inpatient rehabilitation facilities in federal fiscal 2020 by 2.3%, or $195 million, compared to 2019. The proposed rule also would boost payments in urban areas by 2.2% and rural areas by 4.3% compared to the year before. However, payments per discharge for freestanding rehabilitation hospitals are estimated to not increase or decrease in urban areas and decrease by 2% in rural areas, the rule said. (King, 4/17)