Agency moves to tamp down on coupons in exchange plans

In a proposed payment notice for plan year 2020, CMS has taken a page from commercial plan sponsors by seeking to limit the effect of co-pay coupons on patients' total out-of-pocket costs. The goal is to push more plans and patients to try cheaper generics instead.

Co-pay coupons are frequently used by drug companies to skirt formulary placement decisions that place costlier brand drugs on higher tiers, which require expensive co-pays, or leave them excluded altogether. While the coupons eliminate or greatly reduce the co-pay for the patient, it often results in plans paying more for certain drugs when less expensive generics or cheaper brand drugs are available...