After nearly a year of facing the challenging mystery of the COVID-19 pandemic, it appears relief is on the horizon. On December 11 and 18, the FDA granted emergency use authorization to the two mRNA COVID-19 vaccines developed by Pfizer-BioNTech and Moderna. (more…)
COVID-19 had a dramatic impact on work and life. Health care changed dramatically too, with huge drops in emergency room use and an immediate shift to telehealth. But how about dental care? Did it get lost in the “work from home” shuffle? The pandemic’s impact may have actually been bigger on dental than on medical care and prescription drugs. (more…)
For many, finding gratitude and peace during this year’s holiday season will be difficult. 2020 has challenged and changed us. (more…)
There’s a troubling trend among large administrators to prevent plan sponsors from effectively auditing their claims adjudication. Unfortunately, audits are one of only a few ways employers can hold TPAs and PBMs accountable for applying reasonable claim controls. After all, if they win new business by having broad networks, lower discounts, and lower fees, the easiest way to prop up that facade is to automatically pay almost every claim submitted by providers. (more…)
Anyone who’s followed our firm lately has probably heard us talk about the $1 million+ drugs already here and those coming to market over the next few years. While early in the game, we’ve already had a few clients incur enormous claims for these budget-busting medications.
It’s likely many of you reading this are familiar with some of the well-known drugs out there, but according to our latest survey, 73% of employers do not have a plan in place to avoid surprises related to high cost therapies like the ones we’re discussing. And while some of you may have a stop loss policy in place as a safety net to protect against such catastrophic claims, unfortunately, that may not be a foolproof strategy. (more…)
Since the onset of the COVID-19 pandemic, companies across the globe have been working to develop a COVID-19 vaccine. As the pandemic continues on and vaccine clinical trials progress, there may be a possibility of a COVID-19 vaccine being approved for use in the foreseeable future.
The prospect of a vaccine is exciting to most, but also presents challenges for employers. Employers may be considering whether vaccination will be encouraged or mandated.
Employers must navigate the inherent legal risks and logistics of mandating or encouraging employees to receive the COVID-19 vaccine. To do so, employers should seek legal counsel to discuss which course of action is best for their organization. This article provides a general informational overview of considerations for employers. (more…)