HHS Secretary Kathleen Sebelius recently said in a letter to Rep. Jim McDermott, D-Wash., that health insurance plans sold through Affordable Care Act exchanges are not subject to anti-kickback laws. The guidance opens the door to drugmakers' use of copay coupons and other drug discount offers. Industry group PhRMA released a statement welcoming the guidance, but pharmacy benefit managers have been implementing formulary controls to restrict the use of discount cards and coupons.

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