This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments. For more information on how to subscribe to Manatt on Health, please reach out to Barret Jefferds.
Nevada’s Division of Insurance (DOI) announced that it will require state-regulated health plans to apply manufacturer assistance to an enrollee’s cost-sharing obligations under a plan, except when a generic alternative is available. This will end the use of so-called “copay accumulator adjustment policies” in state-regulated plans—a policy in which only enrollees’ direct payment counts toward satisfying deductibles and maximum out-of-pocket spending. The new policy, which begins in the 2025 plan year, will allow enrollees who receive manufacturer assistance to meet their cost-sharing obligations earlier, limiting their overall out-of-pocket spending. According to a 2024 report from The AIDS Institute, more than half of Nevada’s marketplace plans currently use copay accumulator adjustment policies.
For more information on how to subscribe to Manatt on Health, please reach out to Barret Jefferds.