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IRS Expands the Service and Medicines that Can Qualify as Preventative Care for HSA-Compatible HDHPs

The IRS and Treasury Department released Notice 2019-45 yesterday. This notice expands the type of services and medicines that an HSA-compatible High Deductible Health Plan (HDHP) can provide as preventative care for those with chronic illnesses. The notice was released based on direction of the administration’s recent Executive Order on expanding the use and flexibility of HDHPs and HSAs.

The IRS and Treasury issued a list of medical services, items and medicines that can be deemed preventative care for people with specific chronic conditions. According to the notice, the services, items, and medicines have to meet the following criterion:

  • The service, item or medicine is low cost;
  • There is medical evidence supporting high cost efficiency (a large expected impact) of preventing exacerbation of the chronic condition or the development of a secondary condition; and
  • There is a strong likelihood that prescribed the service or item will prevent the exacerbation of the chronic condition or the development of a secondary condition that requires significantly higher cost treatments.

Based upon the above information, the IRS and Treasury released a set list of services, items and medicines that can be treated as preventative care for those diagnosed with the chronic illness listed. If the service, item or medicine is not listed or is used to treat a different chronic illness, then it cannot be considered preventative care.


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 and Treasury state they will review the above list every 5-10 years. Notice 2019-45 is effective as of July 17, 2019. Please note, the list of preventative care benefits are permitted, but not required to be provided by a HDHP. Each carrier offering HDHPs will determine whether or not to incorporate these services, items and medicines for the specific chronic illnesses into their products as preventative care.

DBS will send an update as more guidance is released.