Pharmacy Coupon impact on out-of-pocket expenses: initial guidance was provided for counting coupon amounts for brand name drugs (sometimes referred to as retail drugs) towards the out-of-pocket maximums under the ACA if there was no generic equivalent available. HHS has finalized the regulations applicable to coupons and cost-sharing:
§ 156.130 Cost-sharing requirements. * * * * * (h) Use of direct support offered by drug manufacturers. Notwithstanding any other provision of this section, and to the extent consistent with State law, amounts paid toward reducing the cost sharing incurred by an enrollee using any form of direct support offered by drug manufacturers for specific prescription drugs may be, but are not required to be, counted toward the annual limitation on cost sharing, as defined in paragraph (a) of this section.