The National Association of Insurance Commissioners (NAIC) has advised Robert F. Kennedy, Jr., Secretary of the U.S. Department of Health and Human Services (HHS), of their current federal health insurance policy priorities. The NAIC’s recent letter focuses on two major issues: federal health insurance nondiscrimination rules and regulation of prescription drug copayment accumulator programs.
Federal Health Insurance Nondiscrimination Rules
Newly updated regulations construing Section 1557 of the Patient Protection and Affordable Care Act concern age discrimination. While NAIC agrees with the overarching goal of these provisions, it states that the updated regulations “limit health insurers’ ability to treat enrollees differently based on age or disease status.” The organization expresses concern about the breadth of these provisions and their potential impact on current pricing rules for excepted benefit products, such as dental, hospital, and critical illness insurance. In many states, insurance companies utilize age-based premiums for these products.
Regulation of Prescription Drug Copayment Accumulator Programs
Prescription drug copayment accumulator programs are provisions in health plans that prevent patients from using outside aid for prescription drugs toward their deductibles or out-of-pocket maximums. Patients and their advocates complain that preventing them from using pharmaceutical manufacturer patient financial programs to count toward their out-of-pocket costs can result in an inability to afford necessary medications. In response, insurance companies view these programs as a way to avoid their efforts to discourage patients from using overly expensive medications.
HHS previously developed a copay accumulator rule in 2020. However, when HHS tried to update the rule in 2021, a federal court ruled it to be invalid. Since then, HHS has not enforced the 2020 rule, which remains in place. States have also developed copay accumulator rules but need further guidance on the federal government’s stance.
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