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Sunday, December 3, 2023

Employers Weigh Coverage of Weight Loss Drugs

Employers once again face a rather expensive healthcare conundrum.  The prevalence of so called “GLP-1 drugs”, prescribed ostensibly for weight loss, is causing many to question the cost versus benefit aspect of these drugs.  GLP-1 drugs are showing promise at delivering on the goal of weight loss, but they have not been around long enough to evaluate their long term side effects.  And while demand for these drugs is definitely on the rise, they come at a very high price point.

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Friday, October 27, 2023

Gag Clause Prohibition ~ Compliance Requirement

The Consolidated Appropriations Act (CAA) requires an annual “gag clause prohibition compliance attestation” (GCPCA) be submitted by Dec. 31, 2023, and annually hereafter.  Importantly, carriers/administrators/payers have largely removed any references to gag clauses and prohibitions of sharing pricing and quality data, which was prohibited by the CAA. 

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Friday, June 2, 2023

Insulin Prices Capped by Eli Lilly

After a six year legal battle, drug maker Eli Lilly has agreed to a settlement valued at up to $500 million.  Relatively recently, Congress has taken a keen interest in some of the practices of both manufacturers of prescription drugs, and so called pharmacy benefit managers (PBMs).  Eli Lilly is one of the nation’s oldest manufacturers of prescription drugs, and is largely identified by its introduction of Prozac to market in 1988.  Here are the details of the settlement, which benefits virtually anyone who was prescribed insulin made by Eli Lilly from January 1, 2009 to the date of the settlements final approval –

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Sunday, April 9, 2023

Court Ruling Impacts ACA’s Preventive Healthcare Benefits

The Affordable Care Act’s (ACA) preventive care mandate has been partially struck down by a federal district judge.  On March 30, 2023 the ruling made portions of the preventive care benefit unconstitutional nationwide.  The U.S. Department of Justice has appealed the decision, so there is likely more to come out of this ruling.

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Tuesday, February 14, 2023

COVID Public Health/National Emergency Period Expiring – Impact on Health Insurance

The federal government has announced the current COVID-19 related Public Health Emergency and National Emergency periods will expire on May 11, 2023.  These periods were officially opened and recognized by the government effective January 27, 2020, and were designed to make it easier for the nation to deal with the pandemic. Employers need to prepare for the resumption of the guidance that was in place and changed, during the national state of emergency.

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Thursday, September 1, 2022

UPDATE: Employers Be Aware of the Family Glitch!

One of the chief aims of the Affordable Care Act (ACA) was to address the  challenge associated with finding and purchasing affordable individual health insurance, for those that have no other option for coverage. Some might recall when there was both an INDIVIDUAL and an EMPLOYER mandate, associated with the ACA.  While there is no longer a tax penalty associated with going uninsured (i.e., the individual mandate), there is very much still an opportunity for people to purchase subsidized health insurance coverage through the ACA’s exchanges.  And, with the expected and pending fix of the so called “family glitch”, millions of people will become eligible for subsidized coverage.  Importantly, and speaking of the ACA’s “employer mandate”, employers will need to rethink and possibly restructure premium cost sharing strategies associated with  their group health insurance plan offerings!  

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Thursday, May 12, 2022

Consolidated Appropriations Act – Impact on Healthcare

The Consolidated Appropriations Act of 2021 (CAA), signed into law on December 27, 2020, has far reaching impact, particularly in the area of healthcare financing and delivery.  On it’s surface, the CAA was another coronavirus relief effort, including $900 billion of available funding.  But it’s impact and focus on healthcare is profound and will impact virtually every American citizen.

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Wednesday, January 12, 2022

Home COVID-19 Test Kits Covered by Health Insurance

Earlier this week (January 10, 2022) the White House announced a requirement that most private health insurance payers must cover the cost of home COVID-19 test kits, starting January 15, 2022.  The new benefit waives any plan related cost sharing (e.g., copay/deductible/coinsurance) for the purchase of a limited supply of physician prescribed home test kits.  

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Thursday, December 16, 2021

Expanded List of Qualified HSA/FSA/HRA Expenses

As we approach the end of the year, and for some, the deadline to “use or lose” some or all of their Flexible Spending Account (FSA) balances, we’d like to make stakeholders aware of the expanded IRS list of qualified expenses.

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Wednesday, July 14, 2021

Value-Based Healthcare – What Is It?

There is growing interest in, and implementation of so called – value-based health plans – across the country.  It is a decidedly different way to both deliver and pay for healthcare, and seeks to accomplish the seemingly unattainable goals of lower cost, improved quality of care, with better outcomes.