Participants Using Specialty Drugs to Receive Letter Regarding Important Copay Assistance Information

NRECA is sending a letter the week of September 17, 2018, with updates on the copay assistance program to participants who use or have recently used specialty drugs.

The letter informs participants that, effective January 1, 2019, copay assistance dollars used to help cover the costs of specialty drugs filled at CVS Specialty pharmacies will no longer apply toward their NRECA Medical Plan deductible or coinsurance maximum. Two different letters will go to participants—one to those who have received copay assistance, and another version to those who have not received copay assistance.

Currently, through CVS Caremark’s claims system, the copay assistance portion is recognized as actual dollars spent by the participant. As a result, this money is being applied to the participant’s deductible and coinsurance maximum accumulators.

In 2019, CVS Caremark will track the sources of payment for prescriptions and process separately the dollars that come from copay assistance (often from a drug manufacturer) versus dollars a participant spends out of pocket. Only the participant’s dollars spent out of pocket for specialty drugs will apply toward his or her accumulators.

For example, if a drug is $1,000 and a participant receives $900 in copay assistance, the remaining $100 paid out of pocket will apply to the participant’s deductible and be eligible for reimbursement from a tax-advantaged account (e.g., health flexible spending account, health reimbursement arrangement).

This change will apply only to specialty drugs filled through CVS Specialty and will result in savings to the Group Benefits Trust that will allow for continued affordable medical premiums for participants.

The copay assistance card or coupon amounts that are applied to prescription drugs (specialty or non-specialty) are not eligible for reimbursement from their tax-advantaged account because it is not a qualified out-of-pocket expense. Only the portion the participant pays is a qualified out-of-pocket expense that is eligible for reimbursement.

Participants in a high-deductible health plan who have previously received copay assistance may not meet their deductible as quickly compared to prior years. As a result, they may want to consider contributing more to their tax-advantaged account to compensate for the additional out-of-pocket expense(s).

In addition to the letter, materials are available on the NRECA Employee Benefits website for benefits administrators to share with their employees regarding these copay assistance updates.