Policy Would Let Insurers Ignore Co-Pay Coupons When Computing Deductibles

(image via Unsplash/Laurynas Mereckas)

A new policy proposal from the Trump administration could affect a lot of LGBTQ Americans in terms of healthcare and their wallets.

The Washington Blade reports the Centers for Medicare and Medicaid Services issued a draft rule last month that would allow insurance companies to ignore ‘co-pay coupons’ for prescription drugs in regard to computing a patient’s out-of-pocket spending.


In the past, insurance companies have allowed copay coupons (which reduce prices at checkout) to count towards a patient’s deductible and out-of-pocket limits.

For instance, if you are a gay man who takes PrEP (pre-exposure prophylaxis) as protection against HIV infection, you may be acquainted with Gilead’s Advancing Access co-pay coupon card which pays up to $7,200 annually towards your copay and/or deductible if you have health insurance.

As many have found, when used to cover your PrEP prescription, within one or two months many patients find their deductible or out-of-pocket maximums have been met because the co-pay coupon counts towards those limits. From that point on, you might have low or zero out-of-pocket medical expenses.

But if the proposed rule is adopted, insurance companies could block those coupon payments from being applied towards a patient’s deductible and out-of-pocket maximums – even though the insurance company isn’t having to pay.


Why does an insurance company care where the funds come from as long as the bill gets paid???

In those cases, you would have to pay much more in regard to out-of-pocket spending before reaching your deductible.

And it’s not just HIV medications in play here.

The new policy could affect Americans with hepatitis B or C, who need daily medications to stay healthy in the case of hepatitis B, and for medications to cure hepatitis C which requires treatment for up to 12 weeks.


Donald Trump has said in the past he wants to lower the cost of prescription drugs, but this certainly won’t do the trick.

(stock photo via Pexels)

As the Blade notes, some patients with limited funds sometimes skip a dose of medications here or there to stretch out the drugs they have. But studies have shown that missing just two days of HIV meds can increase an individual’s viral load.

It’s not just HIV or hepatitis patients that could be affected.


A study from the IQVIA Institute for Human Data Science shows in 2017 69 percent of insured Americans did not fill their new prescriptions when they had to pay more than $250 out of pocket. Such non-adherence leads to tens of thousands of preventable deaths each year.

In the end, while Trump may profess to want to help the American people with their healthcare costs, this new policy would only favor insurance companies.

Here’s hoping the new policy proposal is rejected.

(source: Washington Blade)

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