Healthcare

Pharmacy Benefit Management – Part 1

When medication costs go up, insurance costs follow suit because insurance companies have to cover those expenses. So, rising pharmaceutical medication prices can lead to higher health insurance premiums for consumers. If you are self-funded and using a Pharmacy Benefit Manager you need to understand how your PBM is managing the cost of pharmaceuticals.

Employee Benefit Advisors has the expertise to evaluate and work with PBMs. – EBA provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Florida PBM Reform is Here

Effective July 1, 2023 the Florida legislation reshapes the PBM landscape, requiring that PBMs pass through 100% of all manufacturer rebates to plan sponsors, while prohibiting spread pricing, clawbacks, mail order mandates, affiliate-only networks, and other practices that have long been status quo for many in the pharmacy industry.

Florida SB 1550 requires that entities in Florida with a PBM service contract executed on or after July 1, 2023, including a renewal, are required to be pass-through as of January 1, 2024. That may be a challenge for PBMs not accustomed to crediting plan sponsors.

Employee Benefit Advisors is uniquely qualified to help transition companies to meet the new regulatory requirements. We have extensive experience in working with total pass through PBMs and reduced the pharmacy spend for our clients. Contact us for all your compliance questions.

 

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

Fat People Are Costing Your Company

Several years ago, I blogged, Fat People Have Issues, with the disclaimer of posting the politically incorrect title in hopes of getting more people to read. Not being one to suddenly bow to the woke politically crowd I have posted another potentially insensitive title, again, in hopes of getting more people to read. As I said then, I like fat people, many of my friends are fat. So please take it in good humor. I don’t need hate mail. I also recognize some people have genetic challenges. – Bottom line, I’m hoping the information will motivate you to implement a targeted wellness campaign.

Employers bear a large share of excess costs attributed to obesity. Normal-weight employees cost an average of $3,830 per year in covered medical, sick day, short-term disability, and workers’ compensation claims, while morbidly obese employees cost more than twice that amount, or $,8067.

Key Findings from the National Center for Biotechnology Information

  1. Weight loss offers significantly significant savings for obese employees with weight-related conditions, such as diabetes, hypertension, mental health disorders, arthritis and back pain.
  2. The greatest savings potential is for those with the highest baseline body mass index. “This suggests that investments in weight management programs that produce even relatively small amounts of weight loss, when directed at the most obese populations, could provide meaningful savings for employers.”
  3. The greatest savings potential is among non-Hispanic white employees.

Exerts taken from Benefits Pro.

You can read the November 19th, 2014, blog Fat People Have Issues by going to my website www.ebafl.com/blog and searching the title.

 

 Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, 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.

Overpaying for Prescriptions? – Try this

If you are fortunate enough to have health insurance with a low deductible or low-cost prescription co-pays, the high cost of drugs is driving up the premiums that you or your employer pay, making getting health insurance expensive and challenging.

Every American should have access to safe, affordable medicines. If you don’t have insurance or have a high deductible plan, even the most basic medications can be costly.

The Mark Cuban Cost Plus Drug Company, https://costplusdrugs.com,  takes these problems head on. The goal is to dramatically reduce the cost of drugs, but it is just as important to introduce transparency to the pricing of drugs, so patients know they are getting a fair price.

Cost Plus Drugs marks up the price they are able to purchase the prescription by 15%, so they can continue to run the company and invest in disrupting the pricing of as many drugs as possibly. Then they add on the actual cost, $3.00, that their pharmacy partners charge to prepare and provide your prescription to you.

Every product we sell is priced exactly the same way – the cost plus 15%, plus the pharmacy fee, if any. When you get your medicine from Cost Plus Drug Co., you’ll always know exactly how they arrived at the price.

 

 

Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, 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.

Many Patients Billed for Preventive Care That Should Be Free

People are being charged for preventive health care, health care that should be at no cost to them. That’s the headline from an article in the US News & World Report by Robert Preidt, HealthDay Reporter.

The article stated, “Out-of-pocket charges for preventive care that should be free under the Affordable Care Act can discourage patients from receiving recommended care…”. While a majority of patients are receiving preventive care for free, those who were charged only paid about $20 or less.

Unexpected charges were also common for routine screenings for cancer, diabetes, cholesterol, depression, obesity, and sexually transmitted infections, as well as pregnancy-related services.

The primary conclusion of the study was these charges were discouraging future health care screenings.

 

Employee Benefit Advisors provides, employee benefits, Healthcare Consumption Audits, 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.

No More Surprises

Shock by your hospital bill?The No Surprises Act, a ban on surprise medical bills, will take effect beginning in 2022.

Surprise Medical Bills

Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers. – A patient goes to an in-network hospital for surgery or emergency care, and an out-of-network doctor is involved in the patient’s care. Patients are not able to determine the network status of providers, such as emergency room doctors or anesthesiologists. The patient is simply not involved in the choice of provider.

No Surprises Act

The Act applies to surprise bills from doctors, hospitals, and air ambulances. It prohibits these providers from billing patients who have health coverage for unpaid balances. Providers will have to work with the health insurance issuer carrier to determine the appropriate amount to be paid by the plan.

(The No Surprise Act was included in the stimulus bill signed by President Trump on Dec 27, 2020.)

EBA will continue to keep you updated as information becomes available on the details of the law.

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.

Health Care Transparency

New transparency requirements on group health plans and health insurers in the individual and group markets were issued by the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments).

The final rule requires plans and issuers to disclose:

  • Price and cost-sharing information for a list of 500 services must be available via the internet for plan years beginning Jan. 1, 2023. All items and services are required to be available for plan years beginning Jan. 1, 2024.
  • In-network provider-negotiated rates and historical out-of-network allowed amounts on their website for plan years beginning Jan. 1, 2022.

The final rule also allows insurers that share savings with consumers—resulting from consumers shopping for lower-cost, higher-value services—to take credit for those “shared savings” payments in their medical loss ratio calculations.

 

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.

Lifestyle Choices – Creating a Wellness Culture

BenefitsPro ran an article saying… Changing lifestyle choices could cut $730B in annual health care spending and that more than a quarter of all health care spending is due to conditions such as smoking, diabetes and poor diet.

“Nearly three-quarters of a trillion dollars in health care spending can be linked to modifiable health risks, such as obesity, high blood pressure, and smoking…”

There are three key strategies that would prove to be very effective towards changing lifestyle choices.

(1) Preventative – Individuals have a responsibility to be examined at least periodically (every two years, yearly as we get older – I will let the AMA set the standard) and get their immunizations. Those that do receive a premium credit.

(2) Wellness / Biometrics – Smokers should be charged more (no need to argue why, everyone should be aware of the added health risks and costs). Premium credits for those actively managing and meeting standards for blood pressure, BMI, cholesterol, and blood sugar level. People with obesity appear to have triple the risk of hospitalization with COVID-19, compared to people without obesity, the CDC reports. Being severely obese may increase the risk by 4.5 times. – All these biometrics are key indicators of health. Control these factors and receive a premium credit, those that do not should pay more. They are costing everyone else.

(3) Genetics & DNA – Technology is a great tool. Let us use it to help predetermine the medical conditions which we are 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.

An important part of any health care discussions is preexisting conditions.  No one should be denied coverage due to preexisting conditions. However, no one should be allowed to burden the system who carries no insurance, goes to the doctor, learns they need medical care and now applies for insurance. They should be required to apply for insurance, bear a heavy portion of the medical expenses for a year or two (contracted rate), and have the carrier assign a case manager.

How do we pay for preexisting conditions? – Every transaction, buying aspirin, medical procedures, hospital stays – anything medical related – should be charged a ‘PreX’ fee of 1 penny (maybe 2 depending on the accounting). The money would go towards funding preexisting conditions, nothing else. If it raises more than is needed the surplus can be used for cancer or other medical research.

 

 

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.

Bringing People Back to the Workplace Safely & Efficiently

Key to bringing people back is developing and implementing industry best practice safety and wellness protocols.

Meridian’s temperature sensing Personnel Management Kiosk is designed to help protect the health and safety of both employees and guests by helping prevent anyone with a temperature or those without access from entering a facility.

Features

  • Temperature Verification
  • Facial Identification
  • Temperature Threshold Alarms
  • Pedestal & Countertop Configurations

Designed to monitor multiple kiosks in remote locations it is ideal for businesses requiring system security and remote performance management.

Temperature Management Solutions help balance the need to get back to business as quickly as possible while ensuring workplace health and safety. Easy to setup and use. Potential integration, current and development, will make this product a powerful monitoring service tool. More information available at www.meridiankiosks.com.

 

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

COVID-19 and Fat People

I posted Fat People Have Issues November 19th. 2014. – Medical Issues.

Once again, before offending anyone – I posted the politically incorrect title in hopes of getting more people to read. I like fat people, many of my friends are fat. And to be honest, I would like to lose a few lbs. So please take it in good humor. I do not need hate mail. I also recognize some people have genetic challenges.

The statistics for COVID-19 are showing 94% of the deaths have underlying medical conditions, 88% have two conditions and 19% at least one. Elevated blood pressure is the number one underlying medical condition at 53%, overweight 42%, diabetes 32%.

One of the most effective ways to ensure quality healthcare services is to not need it in the first place. All those overweight, please raise your hand. All those currently being treated for a preventable healthcare issue raise your hand. Employee Benefit Advisors has seen, time after time with my own clients, that weight loss is the number one factor to controlling health care costs.

One my biggest beefs with Obamacare is that it did nothing to promote a healthy lifestyle. A good BMI can resolve many medical issues. Maintaining a proper BMI has the potential for the doctor to remove you from your high blood pressure, cholesterol, diabetes, and other medications.

As for COVID-19, it is recommended people with underlying conditions stay home during phase 1 and 2 of the reopening of the economy.

Want more info on the Dietary Impact on Health? Check out https://ebafl.com/dietary-impact-on-health/

 

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

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