More employers are treating maintenance medications, like those treating cholesterol or blood pressure, as a preventative prescription which is eligible for 100% coverage in high deductible health plans. Typically, these prescriptions would be subject to the individual or family deductible, and the consumer would pay the entire cost of the medications until the deductible is met. However, IRS 223(c), exempts preventative health care and prescriptions from the deductible in a high deductible health plan. This lack of clarity regarding the definition of a “preventative prescription” is leading employers to interpret it broadly. According to Mercer’s 2013 National Survey of Employer-Sponsored Health Plans, up to 57% of large employers use a broad definition of a preventative prescription for their high deductible health plans.
Despite the confusion, the IRS has declined to comment on the preventative prescription definitions sent in for comment by employers and health plans. This is leading pharmacy benefit managers to cater to employers that choose to adhere to either a broad or narrow preventative prescription definition. As shown in the Mercer study, most employers are choosing to interpret a preventative prescription broadly as they fear employees will not take high cost prescriptions if they are subject to a high deductible.