Some health plans face change in cost-sharing requirements for lipid-reducing medications

All non-grandfathered health plans will now be required to cover certain statins, or lipid-reducing drugs, for adults ages 40-75, with no cost-sharing requirement for participants. This requirement is effective for plan years beginning on or after November 13, 2017. Plan sponsors of non-grandfathered plans should check with their pharmacy benefit manager to ensure compliance with this new requirement.

The United States Preventive Services Task Force (USPSTF) preventive services regulations announced the new statin requirement.

USPSTF recommendation for ACA

As part of the ACA's final regulations regarding preventive services, the USPSTF will occasionally include preventive services that recommend drug treatments, at no additional cost to participants of non-grandfathered plans.

Recently, the USPSTF recommended low- and moderate-dose statins be provided as a preventive measure to adults ages 40-75 without a history of cardiovascular disease who meet certain criteria.

Effective date

This new requirement is effective for non-grandfathered health plans for plan years beginning on or after November 13, 2017.

Have questions? Contact a Plexus client services team member in Deer Park, Ill. (847-307-6100), Chicago (312-606-4800), Dallas (972 770-5010) or Oklahoma City (405-840-3033).