July 17, 2019
In a successful step for the University of Michigan Center for Value-Based Insurance Design (V-BID)—a cohort focused on lowering financial barriers to high-value clinical services—the US Department of the Treasury released guidance allowing health savings accounts (HSA) and high deductible health plans (HDHP) more flexibility in preventative care coverage.
The guidance grants HSA/HDHP plans the chance to cover some specified medications and services for treatments of chronic diseases before meeting the plan deductible.
“As more and more Americans are facing high deductibles, they are struggling to pay for their essential medical care,” said V-BID Center Director, Mark Fendrick, MD. “Our research has shown that this policy has the potential to lower out-of-pocket costs, reduce federal health care spending, and ultimately improve the health of millions diagnosed with chronic medical conditions.”
According to the Treasury Department and the Internal Revenue Service (IRS), the agencies are aware that cost barriers are preventing many patients from adhering to treatment regimens, as well as potentially utilizing less effective treatment that could exacerbate chronic conditions. “Failure to address these chronic conditions has been demonstrated to lead to consequences,
such as amputation, blindness, heart attacks, and strokes that require considerably more extensive medical intervention,” stated the new guidance.
Under consultation with the US Department of Health and Human Services, the Treasury Department and IRS stated that certain care, services, and items purchased, including prescription treatments for a number of chronic conditions should be considered preventative treatment and therefore covered by these plans.
Per the guidance issued, to be considered for coverage as a preventative treatment, the service or item must show evidence of the following:
- The service or item is low-cost;
- There is medical evidence supporting high cost efficiency (a large expected impact) of preventing exacerbation of the chronic condition or the development of a secondary condition; and
- There is a strong likelihood, documented by clinical evidence, that with respect to the class of individuals prescribed the item or service, the specific service or use of the item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.
This guidance is an extremely significant step for V-BID and comes as a result of over a decade of research and advocacy. V-BID’s goal continues to work to align patients’ out-of-pocket costs, such as copayments, with the value of services.
University of Michigan Center for Value-Based Insurance Design. U.S. Department of the Treasury Announces Additional Preventive Care Benefits to be Provided by High-Deductible Health Plans [press release.] July 17, 2019. http://vbidcenter.org/hsa-guidance-announcement/.