On Monday August 26, the Affordable Care Act (“ACA”)regulators issued ACA FAQ 40.  Prescription benefit managers offer health plans the option of using co-pay accumulators to ensure that prescription drug manufacturer coupons are not counted toward member cost sharing limits. For example, if a member pays $100 out of pocket and uses a manufacturer coupon for the balance, only the $100 payment counts toward, e.g., the plan’s annual out of pocket limit.

In the 2020 ACA Notice of Benefit and Payment Parameters, the ACA regulators advised that health plans are permitted to so exclude the value of manufacturer coupons from the ACA’s member out-of-pocket spending limits when a generic substitute is available. First the advice created confusion over whether the ACA regulators were requiring health plans to adopt co-pay accumulators. That confusion dissipated because the advice was clearly permissive. However, the health plans engaged in broader use of co-pay accumulators reasonably asked for clarification. In FAQ 40, the ACA regulators advised that they would resolve this ambiguity in the 2021 Notice of Benefit and Payment Parameters. Until that Notice takes effect on January 1, 2021, health plans may continue broader use of co-payment accumulators, e.g., beyond prescription drugs with available generic substitutes.

Fierce Healthcare reports on the results of the American Medical Group Association’s annual survey of primary care and specialist physician compensation.  “The 2019 survey shows that physician compensation in 2018 rebounded from a stagnant 2017,” said Fred Horton, AMGA Consulting president. “While productivity also increased, it did not increase enough to surpass the decline we saw in last year’s survey, meaning productivity still has not risen since 2016.”

Modern Healthcare warns that “Physician groups’ public relations, advertising and lobbying blitz against Congress’ front-line proposals to end surprise medical bills reached such a pitch this month that congressional staff worry the entire effort will collapse.”

Forbe’s Healthcare Brainstorm columnist sums up a recent JAMA study on heart disease in the U.S. as follows: “diabetes and high blood pressure are still killing millions of people [in the U.S.]. And communities of color continue to be disproportionately affected by this reality.”

Medicare’s Plan Finder has received an u noteworthy upgrade, according to CMS.

The updated Medicare Plan Finder also provides [Medicare beneficiaries] and their caregivers with a personalized experience through a mobile friendly and easy-to-read design that will help them learn about different options and select coverage that best meets their health needs. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer.