New guidance from the IRS will help people enrolled in high-deductible health plans get coverage for pharmaceuticals to treat a number of chronic conditions.
Under the guidance, medicinal coverage for patients with HDHPs that have certain chronic conditions – like asthma, heart disease, diabetes, hypertension and more – will be classified as preventative health services, which must be covered free with no cost-sharing under the Affordable Care Act.
The background
The guidance, which takes effect immediately, is the result of a June 24 executive order issued by President Trump directing the IRS to find ways to expand the use of health savings accounts and their attached HDHPs to pay for medical care that helps maintain health status for individuals with chronic conditions.
The executive order was in response to a number of reports that have shown that people with HDHPs will often skip getting the medications they need or take less than they should because they cannot afford to foot the full cost of the medication even before they meet their deductible.
This can lead to worse issues like heart attacks and strokes, which then require more and even costlier care, according to the guidance.
The latest move is a significant step that should greatly reduce the cost burden on individuals with chronic conditions, as many of the medications they need to treat their diseases can be extremely expensive.
The IRS, the Treasury Department and the Department of Health and Human Services have listed 13 services that can now be covered without a deductible, and have promised to review add or subtract services from the list on a periodic basis, according to the guidance.
Here is the full list of the treatments, and the conditions they are for:
Angiotensin-converting enzyme (ACE) inhibitors – Congestive heart failure, diabetes, and/or coronary artery disease.
Anti-resorptive therapy – Osteoporosis and/or osteopenia.
Beta-blockers – Congestive heart failure and/or coronary artery disease.
Blood pressure monitor – Hypertension.
Inhaled corticosteroids – Asthma.
Insulin- and other glucose-lowering agents – Diabetes.
Retinopathy screening – Diabetes.
Peak-flow meter – Asthma.
Glucometer – Diabetes.
Hemoglobin A1c testing – Diabetes.
International Normalized Ratio testing – Liver disease and/or bleeding disorders.
Low-density lipoprotein testing – Heart disease.
Selective serotonin reuptake inhibitors – Depression.
Statins – Heart disease and/or diabetes.
The items above were chosen because they are low-cost, proven methods for preventing chronic conditions from worsening or preventing the patient from developing secondary conditions that require further and more expensive treatment.
