On Friday, May, 24 2024, Aimed Alliance and The AIDS Institute met with members of the Nevada Division of Insurance, including Insurance Commissioner Scott Kipper and Chief Deputy Insurance Commissioner Todd Rich, to discuss Aimed Alliance’s letter regarding the 2020 NBPP and the use of non-essential health benefit language in Nevada ACA-regulated plans, as identified in The AIDS Institute’s 2024 Annual Copay Accumulator Report.
During the meeting, the Nevada Division of Insurance announced it had issued guidance stating it would enforce the 2020 NBPP in the 2025 plan year. Read the guidance here (slide 50). Thus, in 2025, all Nevada consumers enrolled in a Nevada marketplace plan will have their copay assistance counted towards their annual limits on cost-sharing in accordance with the 2020 NBPP. *
In addition, in response to Aimed Alliance’s letter expressing concerns with the use of the non-EHB designation in ACA plans, the Division also released new guidance on the use of the non-EHB designation in ACA plans for 2025. The guidance stated:
“It has come to the Division’s attention that some carriers may be intending to not count the cost of the drugs in excess of EHB toward the cost share accumulators, or place dollar or other limits on theses drug benefits. This is viewed by the Division as not being in alignment with the intent of [state law]and prejudicial to the interest of the insured. Any plan incorporating such restrictions will not be approved . . . [for the 2025 plan year].”
This clarification from the Division is important, as Nevada currently has two state marketplace health plans using non-EHB or third-party program language. Therefore, this confirms that these types of policies will no longer be permissible in any 2025 marketplace plans, thereby eliminating consumers’ exposure to these detrimental, costly, and burdensome programs.
This is a HUGE WIN for Nevada health care consumers! Aimed Alliance and The AIDS Institute encourage other State Insurance Commissioner’s to follow Nevada’s leadership and take similar steps to protect health care consumers from copay accumulators, non-EHBs, and third-party programs.
Review these resources to learn more about Aimed Alliance and The AIDS Institute work on this issue:
- Aimed Alliance Letter to NV Division of Insurance regarding 2020 NBPP and Non-EHB Language
- The AIDS Institute 2024 Copay Accumulator Report
- Nevada Division of Insurance 2025 Guidance
*Copay assistance may still be excluded if it is used for a brand name medication with a medically appropriate generic equivalent available.*
Last Updated on May 30, 2024 by Aimed Alliance
