Articles

  • Generic Drug Makers Sued over Pricing Practices

    December 10, 2019
    One of the country’s largest health insurers has sued a number of pharmaceutical companies, accusing them of running a price-fixing cartel of common generic drugs. Humana Inc. has accused the companies of colluding on the prices of generics to the detriment of health insurers that have to pay for these drugs. Humana said in its lawsuit that this collusion prevented fair competition among insurers that could have reduced the cost of many of these drugs. The background The lawsuit comes after 45 states signed on to a suit last year over an alleged scheme among generic drug manufacturers to fix the price of some 300 medications. The states are seeking unspecified damages for what they say they had to overpay for drugs for Medicaid patients as a result of ...
  • New Rules Aim for Hospital, Insurer Transparency

    December 4, 2019
    The Trump administration on Nov. 15 announced two rules that would require more transparency in hospital pricing and health insurance out-of-pocket costs for enrollees. The final rule on hospital pricing will require hospitals to publish their standard fees both on-demand and online starting Jan. 1, 2021, as well as the rates they negotiate with insurers. The administration also proposed rules that would require health insurers to provide their enrollees instant, online access to an estimate of their out-of-pocket costs for various services. The latter are just proposed rules and will have to go through a comment period before final rules can be issued. The two sets of rules are part of the Trump administration’s efforts to bring more transparency ...
  • Reference Pricing Can Reduce Medical Outlays, Costs

    November 26, 2019
    In an effort to coax health plan participants to use price-shopping behavior when deciding on where to have a procedure, more insurers are starting to roll out a system known as “reference pricing.” With reference pricing, the health insurer imposes a limit on the amount it will pay for a particular procedure – a limit that is reasonable and allows access to care for patients. The price is usually a median or average price in the local market. When a health plan participant selects a provider that charges less than the cap, they will receive the standard coverage with little or no cost-sharing. But, if they decide to use a provider that charges more than the cap, the participant will have to pay the entire difference out of pocket. These excess ...
  • Large PBMs Balk at Push to Reduce Drug Prices

    November 19, 2019
    In a move that exemplifies the potential conflict of interest that some large pharmacy benefit managers have, the nation’s largest PBM earlier this year said it would demand that rebates remain unchanged when drug makers roll out new price cuts. Drug makers earlier in the year said they would start reducing prices as well as the rebates they pay PBMs to appease lawmakers and the Trump administration, saying it would reduce the cost of medicine for patients. But not long after the announcement, the nation’s largest PBM, United Healthcare, fired off a letter to drug companies telling them that if they planned to reduce prices and rebates they would have to give seven quarters of notice (that’s 21 months if you’re counting) when they intend to lower prices. ...
  • How to Get the Benefits of Self-Funding without the Risks

    November 12, 2019
    There are typically two approaches to securing health coverage for your staff – group health insurance or self-funding.  Self-funding, however, can be costly and risky and is usually only done by larger organizations with thousands of employees. But there is a hybrid model that can help small and mid-sized employers provide their staff with affordable health coverage: partial self-insuring.  To understand how partial self-insuring works, we should start with the basics of what a self-insured plan is. In a fully self-insured plan, the employer bears the risk of all costs incurred under the plan for claims and administration.   In essence, the employer acts as the insurer and pays claims from a fund that it pays into along with employees, who pay their share of premiums into ...
  • Your Last-Minute Open Enrollment Checklist

    November 8, 2019
    By now you should be prepared and ready to go for your 2020 employee benefits open enrollment. You should have all your plan documents and have prepared or held presentations for your staff to explain the benefits package and any major changes to the plans that you offer.  Employees should be familiar with how to use the enrollment portal and who they should talk to if they have questions.  To be on the safe side, there are a few things you should do to make sure you maximize enrollment, that your employees have the correct materials and that you are in compliance with the law.  Take an active role — Most of the policy selection is done online, but that doesn’t mean you can’t support your employees and let them know you are there in case they have any questions or are ...