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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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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.

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Friday, December 4, 2020

Covid-19 Vaccine and Health Insurance

At present (December, 2020) there are several Covid-19 vaccines in various stages of obtaining approval.  In particular, 2 are likely to hit the U.S. healthcare system in December of this year, from pharmaceutical manufacturers – Pfizer and Moderna – through a process referred to as “emergency use authorization”, or EUA.  The U.S. Food and Drug Administration (FDA) can approve use of vaccines that have made their way through successful clinical trials, for emergency use, before the drugs are authorized for dispensing to the general public.  This blog post addresses some of the pertinent questions relating to the Covid-19 vaccine, such as “who, how, when, why”…

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Thursday, October 8, 2020

Covid-19 Related Health Insurance Update

The U.S. Department of Health and Human Services (HHS) announced on October 2, 2020 that it has extended the period of the national public health emergency related to Covid-19 for a third time.  So, health insurance plans* may now extend the end date of any Covid-19 specific plan related cost sharing waivers and benefits to dates of service up to January 20, 2021.

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Wednesday, August 12, 2020

Post-Retirement Healthcare Budgeting

A question I firmly believe is not asked and answered enough these days is – “how much should I budget for healthcare post-retirement (age 65), assuming I leave my employer (or other) plan and elect Medicare”?  This includes expenses related to medical/dental/vision, care and insurance premiums, and assumes Medicare (and its various parts/pieces) is in place to protect against catastrophic type loss.  Well, the answer might surprise a few folks, and is definitely something to consider if retirement is on the horizon!