John S. Linehan, Member of the Firm in the Health Care & Life Sciences practice, in the firm’s Baltimore and Washington, DC, offices, was featured in the second of a two-part video series in Managed Healthcare Executive, in “Accumulator, Maximizer Regulation Picks Up at the State Level,” with Peter Wehrwein and Briana Contreras.
Following is an excerpt:
With the federal government backing out of regulating coupon accumulators and maximizers, some states have moved ahead with laws that block health plans and PBMs from using them, according to John “Jack” S. Linehan, a lawyer at Epstein Becker Green.
Laws have passed in Arizona, Georgia, Illinois, Virginia and West Virginia that say any payment made by a beneficiary or on the beneficiary’s behalf must count toward a policy’s deductible or out-of-pocket limits, Linehan explained in a video interview with Managed Healthcare Executive®. Laws and regulations that would curb accumulators and maximizers in some way is under consideration in 20 other states, Linehan said. …
Linehan said the state laws are similar to one another, but there are some subtle differences; for example, some apply only to drugs paid for through the pharmacy benefit while others cover drugs paid for through both the pharmacy and the medical benefit. In addition, he noted that any state laws that touch on accumulators and maximizers apply to fully insured plans, not to self-insured plans because ERISA (Employment Retirement Income Security Act) exempts self-insured plans from state regulation.
How accumulators and maximizers will fare under the Biden administration is hard to predict, says Linehan. …
See also Part 1 of the interview: “New Transparency Rules Mean Health Plans, PBMs Must Disclose Their Accumulators, Maximizer Programs,” with Peter Wehrwein and Briana Contreras, in Managed Healthcare Executive.
Also see “New State Copay Accumulator Laws Complicate the Coupon Compliance Landscape,” by John S. Linehan, in Managed Healthcare Executive.