Do Your Employees Understand their Health Insurance Choices?

Do Your Employees Understand their Health Insurance Choices?

Whether we admit it or not, this question has crossed the mind of many a benefits professional — especially as most of us head into open enrollment season. After all, if employees don’t understand their health plan options and appropriate factors to consider in the selection, they could end up making a costly mistake.

Ensuring employees are well educated will not only help them make the right choice, but ultimately lead to increased engagement and productivity. (more…)

Only PBMs Benefit from Rebate-driven System [UPDATE]

Only PBMs Benefit from Rebate-driven System [UPDATE]

UPDATE: The following piece was originally posted to Linked In by Rick Chelko on June 28, 2018. Shortly thereafter, Rick met with a senior Health & Human Services (HHS) official working on drug pricing reform to discuss this and related issues. Ironically, the official expressed concern that the marketplace might view the removal of safe harbor protection for rebates to be “a windfall for Big Pharma.”

Nonetheless, we were pleased to see the Office of Inspector General (OIG) and HHS submit a proposed rule change on July 18 to the Office of Management and Budget (OMB). This proposed rule appears to remove the safe harbor protection for prescription drug rebates under the Federal Anti-Kickback Statute. If and when the rule will be finalized is unclear, as is the effective date. Here’s hoping that it will be soon.

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Deep Dive Roundtable Makes a Splash

Deep Dive Roundtable Makes a Splash

We believe employers who know their numbers make better plan decisions. We also believe there is value in employers talking to each other about their respective challenges and solutions.

These are the fundamental principles behind our annual “Deep Dive” Roundtable in Columbus. It’s a simple concept really — as plan managers, it’s important to understand what’s driving costs. But tracking and analyzing health plan performance data can occasionally get lost in the recurring waves of vendor implementations and renewals, wellness events, open enrollment, HRIS system changes, or whatever else is the benefits priority of the quarter. (more…)

Right to Try: Beneath the Surface

Right to Try: Beneath the Surface

A bill allowing patients with serious illnesses to try unproven experimental treatments has been approved by Congress and is now on its way for signature by a supportive President.

For the sake of this discussion, let’s put aside some of the safety and ethical concerns. On the surface, everything may seem palatable from a plan sponsor perspective. But that’s until you start pondering some of the potential issues lurking beneath the surface. (more…)

Back to the Future: Is it Time to Bring Back R&C?

Back to the Future: Is it Time to Bring Back R&C?

Most if not all medical third-party administrators (TPAs) use “shared savings” programs to reduce the cost of non-network claims.

In the absence of a shared savings program, plans pay billed charges without any discounts after members pay the higher non-network copay/coinsurance. But with shared savings programs, TPAs use secondary (aka “blind”) networks, or negotiate directly with providers for discounts. And in return for their efforts, TPAs usually keep 25% to 35% of the savings. Are you following? (more…)