Human Resources

Pharmacogenetics

Pharmacogenetics allows prescribers and pharmacists to understand how medications react differently in the body based on an individual’s metabolism. Best Practice PBMs are able to apply the results of a fast and easy-to-administer pharmacogenetics test to enhance member safety, improve treatment outcomes and prevent wasteful drug spending.

The science of pharmacogenetics utilizes precision medicine, which evaluates and considers a patient’s metabolism, environment and lifestyle, to develop effective, individualized treatment plans. Pharmacists work with members and their prescribers to coordinate changes in drug therapies, as indicated by testing. This ensures that members receive the most clinically appropriate and effective medications. By proactively identifying which drug therapies will not work, or are likely to cause severe adverse reactions, clients and their members can avoid unnecessary risks and expenses.

Pharmacogenetic testing can have a measurable positive impact for members who live with chronic health challenges such as diabetes or high cholesterol. Pharmacists can help them move quickly onto the most appropriate drug therapy and improve their health with fewer side effects and less risk, based on their unique metabolism.

There are no doctor’s visits required to administer the test. Members can collect and submit the sample from home using a simple cheek swab. The markers identified by pharmacogenetic testing do not change over a member’s lifetime, so repeat tests are not required.

Pharmacogenetics enables a personalized approach to care aimed at reducing costs, improving treatment efficacy and preventing adverse drug reactions.

Please contact me if you would like to learn more.

 

Employee Benefit Advisory provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

PBM – Looking for transparency?

Are you contracting with a large PBM because they offer great discount? You might want to rethink your strategy and look to smaller PBMs with complete transparency. Perhaps it’s time to consider a pharmacy benefits administrator that offers the following:

  • A straight forward pricing model with no hidden revenue generators such as spread pricing. Look for invoice of the exact amount that reflects retail contracts. No spread should be retained for brands or generics.
  • Minimum retail guarantees, not maximums or estimates. If better rates are negotiated during the contract term, the PBM should pass through those discounts.
  • Mail order prescription charges based on the actual acquisition cost.  The amount billed should match the invoice cost, plus a fixed dispensing fee. Is your BPM willing to provide mail order purchasing invoices to validate their actual acquisition cost?
  • “Generic” and “Brand” defined exactly as Medispan does– no change in definitions.
  • No financial interest in any pharmaceutical manufacturer. BPM should pass through 100% of rebates received associated with a client’s brand utilization.
  • Fulfilled promises.  Annual reconciliation occurs and the BPM will make up any loss where the guarantee is not met by paying clients back for each dollar over the amount that was guaranteed.

Who is Employee Benefit Advisors describing? Contact us and make a referral on your behalf.

 

Employee Benefit Advisory provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Knock Out Blow? – Trump Ends Cost-Sharing Reduction Subsidies

The White House confirmed Thursday that it will stop making federal payments for cost-sharing reductions, payments to health insurers. The Department of Health and Human Services confirmed that the cutoff would be immediate. This action could throw the Marketplace into immediate turmoil as insurers start to evaluate their options for 2018.

Many, certainly democrats, have been calling for a bi-partisan solution to the health care problems in America. However, let’s not forget, it was the democrats that ramrodded the misnamed Affordable Health Care Act through the legislative process, behind closed doors, with absolutely no input from republicans.

Employee Benefit Advisors has blogged several times about legal challenges to the ACA, specifically pin pointing, the Obama administration saying they did not receive, but needed, an appropriation to make these payments to insurance companies. Obama used executive orders to put into place key finance regulations behind the ACA. Problem is, what can be done by executive order can be undone by executive order.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Trump’s Executive Order – What it is & What happens next

President Trump signed an executive order in an attempt to improve access, increase choices and lower costs for healthcare.

What Is in the EO?

The EO directs the secretary of Labor to consider proposing regulations or revising guidance to expand Association Health Plans. The intent of this directive is to allow employers in the same line of business anywhere in the country to join together to offer healthcare coverage to their employees. It could potentially allow employers to form AHPs through existing organizations, or create new ones for the express purpose of offering group insurance. This could lead to the sale of insurance across state lines through AHPs; however, more action will need to be taken by the Department of Labor before this option can be available.

The EO directs the secretaries of HHS, Treasury and Labor to consider proposing regulations or revising guidance to expand short-term limited duration insurance (STLDI). This directive would allow the agencies to revisit the rule enacted by the Obama Administration that limited the length of STLDI plans to three months.

The EO directs the secretaries of HHS, Treasury, and Labor to consider proposing regulations or revising guidance to expand Health Reimbursement Arrangements. The intent of this directive is to allow employers to contribute more to their employees’ HRAs. HRAs are employer-funded accounts that reimburse employees for healthcare expenses, including deductibles and copayments. The IRS does not count funds contributed to an HRA as taxable income. The intent of this directive is to expand HRAs, which could provide employees with more flexibility in how their healthcare is financed.

What Happens Next?

The EO directs the secretary of Labor to act within 60 days to consider proposing regulations or revising guidance on AHPs. It also directs the secretaries of Treasury, Labor and HHS to act within 60 days to consider proposing regulations or revising guidance on STLDIs, and for the agencies to act within 120 days to consider changes to HRAs.

Within 180 days, the secretary of HHS, in consultation with the secretaries of Treasury, Labor and the Federal Trade Commission, must report to the president on state and federal laws, regulations and policies that limit healthcare competition and choice, as well as on actions that federal and state governments could take to increase competition and choice and reduce consolidation in healthcare markets.

The EO does not direct the agencies to adopt specific regulations; therefore, in order for any policies to change, the agencies will have to go through the traditional rule-making procedures of providing a proposed rule for public comment before being able to enact any final rules.

What about Open Enrollment for 2018?

At this time, nothing in the EO will affect open enrollment for 2018 unless regulatory action is taken by the agencies. Until any such regulations are enacted, the ACA and all of its regulations, penalties and enforcement remain.

 

Content provided by a statement from the National Association oh Health Underwriters of which Employee Benefit Advisors is a member.

What is Reference Based Pricing?

With RBP plans are designed to negotiate treatments with high-quality providers at reduced costs and can work in different ways, depending on the insurance carrier or TPA. – Sound like a PPO or HMO? Not quite.

RBP can have no network restriction, a network and use a network within a network. Call it Creative Networking where certain services may require the use of select networks, a Network within a Network.

All reimbursements are based on a fixed amount for a particular procedure, such as dialysis and hospital stays – two biggies, which certain providers will accept as payment in full. Reimbursement is based on a reasonable fee or multiple of Medicare. Under this type of arrangement, reimbursement rates range between 120% and 180% of Medicare.

RBP product could offer you 72-77% savings over traditional PPO plans. (A national survey found less than 1% of providers do not accept this type of health benefit plan.)

 

 

Discover the referenced based pricing solution that offers a significant improvement in savings without compromising quality care. Save on claims costs without provider and facility restrictions.

 

Employee Benefit Advisory provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Rx Refills made easy!

Don’t like lengthy waits to refill your prescriptions? Prefer to have refills delivered to your door? Prefer someone else troubleshoot insurance & renew refills for you? Let me introduce you to Phil.

Phil is a service that manages your ongoing prescriptions. Phil partners with top-rated, locally-owned pharmacies that are licensed by the Pharmacy Board. These pharmacies will deliver your medications to you on time and answer any questions over the phone. Using the Phil app, you are able to refill on your own terms by scheduling when your medications arrive, ordering vacation refills etc.

Welcome to Phil – Smarter Prescription Refills: same copay, free delivery and a real time saver.

 

Phil takes 3 easy steps.
Step 1 – Sign Up and add your existing prescriptions to Phil.
Step 2 – Phil does the rest, they contact your old pharmacy and do the paperwork.
Step 3 – Receive your meds. Partner pharmacies deliver meds to your doorstep every month.

All partner pharmacies are rated 4-5 stars on Yelp®

Delivery is free. Phil will guarantee your copay will be the same as what you pay at your current pharmacy. Some rare exceptions may apply; in those cases, you’ll be contacted for approval. If you don’t have insurance, Phil partner pharmacies will quote you the lowest price they can obtain for you.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Social Security – Where’s the AARP?

Do you know when you retire you may be paying taxes on your Social Security income? And yes, you already paid taxes on that income. It’s double taxation. (Our friends in Boston that had a bit of a tea party would love this one.)

Not everyone pays though. Only high income earners. – When you retire will you be a high income earner? – Don’t think so? I suggest you take another look. The government says “This usually happens only if you have other substantial income (such as wages, self-employment, interest, dividends and other taxable income that must be reported on your tax return) in addition to your benefits.”

And, they try to soften the blow by saying “No one pays federal income tax on more than 85 percent of his or her Social Security benefits based on Internal Revenue Service (IRS) rules.”

Who pays? You do, if you

  • file a federal tax return as an “individual” and your combined income* is
    • between $25,000 and $34,000, you may have to pay income tax on up to 50 percent of your benefits.
    • more than $34,000, up to 85 percent of your benefits may be taxable.
  • file a joint return, and you and your spouse have a combined income* that is
    • between $32,000 and $44,000, you may have to pay income tax on up to 50 percent of your benefits
    • more than $44,000, up to 85 percent of your benefits may be taxable.
  • are married and file a separate tax return, you probably will pay taxes on your benefits.

Note: Your adjusted gross income + nontaxable interest + ½ of your Social Security benefits = your “combined income”

And the income levels mentioned above are not adjusted for inflation.

Clients and followers of Employee Benefit Advisors know that despite being well versed in investing and retirement planning we do not dabble in retirement benefits. Our practice is strictly Health & Welfare. We decided to blog bout this issue because every time this topic comes up people are stunned.

Do you want to change this law? Write the AARP. How did they let this get through and why are they not addressing this issue?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Men are the problem!

Men don’t go to the doctor unless their arm or leg is falling off or they are dying. Consequently they are a major reason for the large preventable claims your company is incurring. So men, get a reality check, and become a smart patient.

Human Resource Directors, read the following then think about this recommendation. “Employees that have their annual wellness exam should pay less for their employer provided health insurance.” (This recommendation is good for women as well, you don’t want to discriminate. And you can implement this staying HIPAA compliant.)

Guys, you may feel fine, but the numbers don’t lie: More men than women are likely to be diagnosed with diabetes and kidney disease. And according to the Centers for Disease Control and Prevention (CDC) 12.1% of US men have circulatory diseases like coronary heart disease, heart attack and stroke. Your body may be suffering from silent conditions that have little or no symptoms, such as hypertension or colon cancer. About 3.5 million people are diagnosed with skin cancer every year, and men are more likely than women to die from melanoma, the deadliest form of skin cancer.

You should talk to your doctor about your risk of prostate cancer – especially if you’re over 50, African American, or if prostate cancer runs in your family. If you’re a baby boomer, you should get tested for hepatitis C (HCV). More than 75% of adults infected with HCV, often a symptomless disease, were born between 1945-1965. Left untreated, HCV can cause life-threatening diseases such as liver damage, liver cancer and cirrhosis.

So no more excuses. The old “ignore-it-and-it-will-go-away” approach doesn’t work. It’s time to get informed and become a smart patient. Make that doctor’s appointment now.

Statistical information came from sharecare, www.shaecare.com, a great resource for men and women’s health.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

IRS Guidelines – Indexed for 2017

FICA
Social Security Tax is 6.2% on income up to $127,200 up from $ 118,500.
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,300 / $2,600
Maximum Out-of-Pocket Limit (Individual/Family) $6,550 / $13,100

Health Savings Accounts
Individual / Family $3,400 / $6,750
Catch-up Contribution $1,000

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,600
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rate
53.5 cents per mile for business miles driven
17 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations
Parking (monthly) $255
Mass Transit Passes (monthly) $255

Compensation
Compensation Limit $270,000
Highly Compensated Employee Salary Amount $120,000
Annual Compensation for Key Employee $175,000
Defined Benefit Plan Limit $215,000
Defined Contribution Plan Limit $54,000

Retirement Plans
401(k) $18,000
401(k) Catch-up $6,000
403(b) $18,000
457(b)(2) and 124(c)(1) $18,000
457(b) Catch-up $6,000
IRA Limit $5,500/$6,500 for age 50+
Simple IRA Limit $12,500/$3,00 Catch-Up

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Health Insurance As It Should Be (Part 2 of 2): Preventative, Wellness & Biometrics, Genetics & DNA

Under the ACA preventative care was free. At least there was no charge to the insured at the time they received the exam, the cost was built into the premiums. The argument was that an advanced diagnosis would save long term medical costs because illnesses would be caught at an early stage.

If we use that same argument to create “health Insurance as it should be” there are three key strategies that would prove to be very effective.  Here they are and here’s how to use them. (1) Preventative – Individuals have a responsibility to be examined at least periodically (every two years, yearly as we get older – I’ll let the AMA set the standard) and get their immunizations. Those that do receive a lower insurance premium. (2) Wellness / Biometrics – Smokers should be charged more (no need to argue why, everyone should be aware of the added health risks and costs). Lower premiums or premium rebates for those actively managing and meeting standards for blood pressure, BMI, cholesterol and blood sugar level. All are key indicators of health. It makes sense to provide a premium discount to the individual going to the gym or utilizing some other method to improve their health. Those that don’t should pay more. After all, they are costing everyone else more. (3) Genetics & DNA – Technology is a great tool. Let’s use it to help predetermine the medical conditions which we’re predisposed. Not to punish people with higher costs, but to be proactive. A lifestyle change at an early age could help prevent certain illnesses. Information can be kept confidential with case managers and not shared or used with underwriting. – i.e. If you knew you had a family history of cancer, breast or colon, you could be proactive and monitor the signs. Same principle for other genetic diseases.

Let’s use all the available resources to lower health care costs and create a proactive system, health insurance as it should be.

What ideas do you have?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

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