What that would mean for patients who rely on those fills counting toward their deductibles, should insurers take the pass offered by HHS, is that not only would those patients be on the hook for their own deductibles—but that, when they reach their max on their copay cards, if they haven’t yet met their deductible, they’re also on the hook for whatever their share of the cost of those meds is until they do hit their deductible.

Even as prescription drug costs remain an important pocketbook issue for many Americans, the Trump administration has taken a new step that will likely raise expenses for many patients, a move that consumer advocates find upsetting and puzzling.