CMS’s New Transparency Rule Requires Plans to Disclose Copay Accumulator Programs and Other Details


On October 29, 2020, the Centers for Medicare and Medicaid Services (CMS) released a new rule aimed at improving transparency in health plans. Among other things, it requires individual and group health plans to release a statement to consumers disclosing their cost-sharing requirements with respect to a certain treatment or service. The same statement must also include information about whether the plan has adopted a copay accumulator program (i.e., whether the plan will exclude copay assistance or other third-party payments from the calculation of the patient’s deductible or out-of-pocket maximum). The health plan must make this information available through an internet-based self-service tool, and the information provided in that tool must be in plain language, without a subscription or other fee, and offered in real-time. This information must also be available in plain language in paper format and without a fee upon request of the patient. This change will go into effect for plans beginning on or after January 1, 2023 with respect to a list of 500 items and services, which will be posted on a publicly available website and on or after January 1, 2024 for the remainder of covered items and services. Read the full rule here.


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