On Wednesday, July 17, the Internal Revenue Service (IRS) released a notice that names additional medicines and services that can be treated as preventive care and qualify for HSA eligibility under high deductible health plans (HDHPs) for those with chronic conditions.
This Notice (Notice 2019-45) follows a directive by President Trump in a recently released executive order, directing the IRS to provide guidance on how HDHPs could be designed to provide low-cost chronic condition management before the deductible, while also maintaining HSA eligibility. The IRS has identified the following list of chronic condition management items that are specifically prescribed to prevent the exacerbation of the chronic condition or the development of a secondary condition:
| Preventive Care for Specified Conditions | For Individuals Diagnosed with |
|---|---|
| Angiotensin Converting Enzyme (ACE) inhibitors | Congestive heart failure, diabetes, and/or coronary artery disease |
| Anti-resorptive therapy | Osteoporosis and/or osteopenia |
| Beta-blockers | Congestive heart failure and/or coronary artery disease |
| Blood pressure monitor | Hypertension |
| Inhaled corticosteroids | Asthma |
| Insulin and other glucose lowering agents | Diabetes |
| Retinopathy screening | Diabetes |
| Peak flow meter | Asthma |
| Glucometer | Diabetes |
| Hemoglobin A1c testing | Diabetes |
| International Normalized Ratio (INR) testing | Liver disease and/or bleeding disorders |
| Low-density Lipoprotein (LDL) testing | Heart disease |
| Selective Serotonin Reuptake Inhibitors (SSRIs) | Depression |
| Statins | Heart disease and/or diabetes |
The IRS states “services and items not listed in the Appendix (list above) that are for secondary conditions or complications that occur notwithstanding the preventive care are not treated as preventive care for purposes of section 223(c)(2)(C).”
That language appears to indicate that the IRS views the above list as the only services, prescriptions, or items that exhibit the characteristics outlined below that the IRS has identified as evidencing ability to be treated as preventive care under an HDHP:
The service or item is low cost;
There is medical evidence supporting high cost efficiency of preventing exacerbation of the chronic condition or the development of a secondary condition; and
There is strong likelihood that this service or use of the item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.
However, the IRS states it will consult with the Department of Health and Human Services on a periodic basis to review the list and determine if services or items should be added or removed.
