CMS Finalizes NBPP Rule, Limiting Copay Accumulators, Increasing Premium Adjustment Percentage

By Consumers For Quality Care, on May 8, 2019

Photo by Heidi de Marco/KHN

CMS has finalized the 2020 Notice of Benefit and Payment Parameters rule (NBPP), which provides insurance companies with guidelines to create their 2020 plans. The rule, amongst other things, continues automatic reenrollment, limits the instances that insurers are allowed to use copay accumulator programs,  and increases the premium adjustment percentage, Health Affairs explains.

In a win for consumers, the rule continues to allow automatic reenrollment for insurance plans. Automatic enrollment both keeps enrollment convenient for consumers and reduces costs for insurance companies.

The final version of the rule also continues to allow insurers to implement copay accumulator programs, which keep pharmaceutical manufacturer coupons from applying to consumers’ out-of-pocket cost limits when there are generic alternatives. However, insurance companies are prohibited from using copay accumulator programs when there are no generic options available.

Patient advocacy groups say limits on the use of copay accumulator programs are a win for consumers. The AIDS Institute applauded CMS’ decision to reign in the use of the programs:

“We are pleased that CMS is putting an end to these harmful and deceitful insurance company and PBM practices,” commented Carl Schmid, Deputy Executive Director of The AIDS Institute. “People living with serious and chronic conditions, such as HIV and hepatitis C, depend on copay assistance to afford their drugs, particularly at a time when so many plans have high deductibles and charge high co-insurance.”

Unfortunately for consumers, the NBPP increased the premium adjustment percentage. The premium adjustment percentage impacts how much consumers can pay for their maximum out-of-pocket costs, increases the amount that consumers are responsible for paying and lowers premium tax credits available. The Center on Budget and Policy Priorities found that the increase, roughly 1.3 percent, will make plans more expensive for 7.3 million consumers with exchange plans. The rule change was widely criticized during NBPP’s comment period.

All commenters on this issue opposed or expressed concern about this change to the percentage, citing CMS’s own projections of decreased enrollment and higher premiums and out-of-pocket costs.