November 5, 2013
A new memorandum issued by the Center for Consumer Information and Insurance Oversight (CCIIO) appears to pivot away from a recent letter from Health and Human Services (HHS) Secretary Kathleen Sebelius stating that federal anti-kickback provisions do not prohibit providers, drug manufacturers and others from using kickbacks to induce greater use of their products and services in Affordable Care Act (ACA) coverage.
Copay coupons for brand name drugs and other kickback schemes are designed to induce patients to ignore formularies, networks, and other tools that make benefits more affordable by encouraging patients to choose generic drugs and other less expensive options.
The memo states that although “it had been suggested” that third-party providers and companies could cover patient premiums and cost-sharing in the exchange plans, the agency “has significant concerns with this practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS discourages this practice…”
Interestingly, neither Secretary Sebelius’s statement nor the memorandum reflects a formal change in federal rules on the issue.
“Now regulators need to take the next step and formally determine what everyone already knows: that federal anti-kickback laws apply to the ACA,” said Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt.