FAQs: Coupon accumulator adjustment

November 6, 2019

It applies to plans with Specialty Select when medications are purchased at AllianceRx Walgreens Prime (ARxWP).

The program discontinues the practice of applying coupon values to member accumulators, such as deductibles and out-of-pocket maximums (OOPM).

For high-deductible plans, all manufacturer coupons are affected. For all other health plans, only coupons for drugs that have a generic alternative will be affected.

This program will help address the role drug manufacturer coupons play in steering members toward higher-cost brand-name drugs in order to drive up plan costs. The program will reduce costs for employer groups and provide a new plan management option consistent with competitors with similar programs, all while remaining compliant with regulatory requirements.

• Members with Specialty Select who use coupons when filling a prescription at ARxWP won't have the coupon value applied to their accumulators, such as their deductible and OOPM.
• These members will still be able to use manufacturer coupons to reduce their out-of-pocket cost at the point of service; however, it will take them longer to meet their deductible and OOPM because those coupon values won't apply to their accumulators.
• Members who used a coupon when filling a medication at ARxWP in the past four months will receive a letter before Jan. 1, 2020, informing them of the change.

• Manufacturer coupon values for specialty and non-specialty drugs filled outside of ARxWP will continue to accrue to accumulators, but they'll be be backed out manually when detected or reported.

(August 2019 data)

We can track coupon usage automatically through a special arrangement with ARxWP. This capability is not available with other dispensing pharmacies. If we learn of members who use coupons for specialty drugs they purchase elsewhere, we'll manually back out any accumulator credit that has been given for the coupon amount.

If the group doesn't have Specialty Select, but has a member who fills at ARxWP, will the coupon program still apply to the member?

No. This program applies only to groups with Specialty Select when members fill their medications at ARxWP.

Yes. The coupon program will be implemented for all fully insured plans (all fully insured plans have Specialty Select). For all high-deductible health plans, any coupon used at ARxWP will apply to the program. For all non-high-deductible health plans, there is a list of drugs, the Condensed List (below), that will be used. All these drugs have manufacturer coupons and generic alternatives.

Condensed List

*This list of drugs can be changed by the manufacturer at any time as they add or remove coupons.

Drug manufacturer coupons conceal from patients the true cost of brand-name medications. In addition, coupons increase the cost of health care overall, as health plans and self-funded groups absorb the offsets from manufacturer coupons when members don't use out-of-pocket funds to meet their accumulators. Furthermore, drug coupons encourage members to select higher-cost drugs when lower-cost alternatives are available.