CMS Final Rule | Creditable Coverage Status & Disclosures

The CMS final rules were released with important updates impacting creditable coverage requirements. Notably for employer group health plans, disclosure to individuals and reporting to CMS is no longer required for account-based plans, including HRAs (such as ICHRAs), HSAs, and FSAs. In addition, beginning with 2027 determinations, plans must either apply the revised simplified determination method or obtain an actuarial determination to assess whether prescription drug coverage is creditable. Under the revised simplified method for 2027 plans, plans must meet the following criteria: (i) reasonable coverage for brand name and generic prescription drugs and biological products; (ii) reasonable access to retail pharmacies; and (iii) designed to pay on average at least 73% percent of participants’ prescription drug expenses.