New Oklahoma Law Could Knock Out HSAs

What You Need to Know

The problem is that the federal HSA law requires an HSA holder to have skin in the game.
Oklahoma's law allows patient use of coupons, grants or other outside money to cover cost-sharing payments.
When that happens, patients can become ineligible to contribute to their HSAs.

Oklahoma has a new prescription drug cost-sharing law that could break some consumers’ health savings accounts.

The Oklahoma Insurance Department has put out an alert to warn HSA holders about the new law.

The problem is that the federal HSA law requires an HSA holder to have “skin in the game” — a large enough deductible to push the HSA holder to be a careful health care shopper.

For an HSA holder who uses manufacturers’ coupons, grants or other outside money to pay for expensive prescription drugs, the new Oklahoma law could remove too much patient skin from the game.

When that happens, “the individual becomes ineligible to contribute to their HSA,” the department says in the alert.

“HSA holders should talk to their health insurers or health insurance agents to make sure they understand the effects of the new state cost-sharing payment rules, the department says.

H.B. 2678

The new Oklahoma law was created by H.B. 2678, which passed with little opposition. It requires health insurers to include drug manufacturers’ coupons, cash from charities, and other payments from third parties when determining whether patients have met their plan deductibles or reached their annual out-of-pocket spending maximums.

Skin in the Game

Insurers want to see patients use some of their own money to pay for expensive drugs, to encourage patients to make sure that using expensive drugs is necessary.

Federal law supports the idea of giving patients “skin in the game” by requiring an HSA user to combine an HSA with a high-deductible health plan.

The new Oklahoma law favors patients who would rather not have large amounts of skin in the game.

Oklahoma may be just one battleground for advocates and critics of giving prescription drug users large amounts of skin in the game.

The National Council of Insurance Legislators recently adopted an NCOIL Accumulator Adjustment Program Model Act. State lawmakers throughout the country can use the NCOIL model to develop bills similar to the new Oklahoma law.