How drug coupons could affect your out-of-pocket costs

As October comes to a close, open enrollment programs are kicking off nationwide and employees at companies large and small will make pivotal benefits decisions.

In this week's edition of HSA Headlines, we'll take aim at two trends that could factor into how HSA users make contributions this fall, and whether recent regulation changes or prevailing health care trends could cause them to miss the mark on their contribution this year.

Drug manufacturer coupons and out-of-pocket limits: What employers need to know - Andrew Silverio, BenefitsPro

To contribute to an HSA, you have to be enrolled in a high-deductible health plan (HDHP), and these plans have out-of-pocket maximums that dictate when you've reached your deductible and insurance will now start covering expenses in full. For 2020, an HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $6,900 for an individual or $13,800 for a family (Healthcare.gov). The cost of prescription drugs is a major consideration here, and a recent change by the Centers for Medicare/Medicaid Services (CMS) may change the calculus of HSA users.

The change in question: "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."

What does it all mean? This ruling is meant to drive health plan users to consider generic alternatives, but this could be a sore spot for HSA users looking to hit their deductible limit as quickly as possible. As it stands, throughout the duration of 2020, plans will be able to exclude manufacturer coupon amounts from annual out of pocket maximum accumulators.

So, even if an account holder finds a better deal with a manufacturer coupon, it may be denied by the plan administrator. As of now, there is no list of "exempted drugs" that the CMS is trying to cover, but this is something that should be factored into HSA users' plans as 2020 gets underway.

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Source: Sean Hanft of HSAStore.com