by US Rx Care | Feb 2, 2021 | Uncategorized
The $900 billion COVID-19 relief bill, passed by Congress and signed into law on Dec. 27, includes a number of provisions that affect employers and their workers in terms of paid sick leave and Emergency Family and Medical Leave Act provisions.
The legislation also boosts unemployment benefits to out-of-work Americans, as well as reopening and expanding the Paycheck Protection Program that was introduced in March as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Paid sick leave and family medical leave
The new law has not extended the obligation for employers to provide emergency paid sick leave and expanded family and medical leave beyond Dec. 31, 2020, instead making it voluntary after that date.
From Jan. 1, employers can continue receiving tax credits if they provide emergency paid sick leave (EPSL) and emergency family medical leave (EFML) to employees for COVID-19-related purposes through March 31. Here are the caveats:
- Tax credits will be available for leave granted to employees who did not already exhaust 80 hours of EPSL and 12 weeks of EFML. For example, if a worker who was entitled to 80 hours of EPSL last year used 50 of those hours, they’d have 30 hours left to use between Jan. 1 and March 31 this year.
- Employers must protect the jobs of any employee that is granted EPSL and EFML.
Other provisions
The legislation extends some CARES Act unemployment programs:
Unemployment benefits ― The new law extends the Federal Pandemic Unemployment Compensation (FPUC) program supplement from December 26, 2020 to March 14. However, instead of receiving $600 a week under the original program, benefits will be $300 per week.
Gig worker unemployment benefits ― The law also extends the Pandemic Unemployment Assistance (PUA) program, which covers independent contractors and gig workers who would usually not be eligible for unemployment insurance payments.
This program (originally created by the CARES Act) is also extended to March 14, and then a three-week phase-out period begins and will run until April 5. The law increases the number of weeks independent contractors are eligible for these benefits to 50 from the original 39.
Extra weeks for those whose benefits ran out ― The Pandemic Emergency Unemployment Compensation (PEUC) program, which provides additional weeks of unemployment insurance benefits to individuals who use up all of their state unemployment benefits, will be extended until March 14.
The law also increases the number of benefit weeks to 24, from 13 under the original version of the program. After March 14, this program will be phased out over three weeks until April 5.
More money ― Taxpayers with annual incomes below $75,000 will receive a $600 check, plus another $600 per dependent child. Payments are phased out for people with incomes in excess of $75,000.
Paycheck Protection Program (PPP) part II ― The law also sets aside $284 billion for forgivable loans to struggling businesses as part of a second PPP. Companies that receive funds will have to use the money on payroll and other specific expenses if they want the loan to be forgiven.
Depending on the loan, employers will have either eight or 24 weeks after receiving the loan to spend it on approved expenses.
But PPP part 2 does have some additional prerequisites that differ from the original. It lowers the employee threshold for businesses to 300 employees or fewer (down from 500). Additionally, the maximum loan is now $2 million, compared to $10 million under the original PPP.
Qualifying expenses are also different in this version, which means any business thinking about applying needs to read all the fine print.
by US Rx Care | Jan 28, 2021 | Uncategorized
The soaring cost of new prescription drugs is becoming a major driver in overall health insurance price increases, and some of those drugs are so expensive that they are out of reach for the average patient.
When people can’t afford the drugs their doctor prescribes for their ailments, it can result in either severe financial strain (even for those with insurance) or, if they can’t buy the medication at all, serious consequences for their long-term health.
What’s driving these cost increases? Patients are paying more because of:
- High launch prices of new brand biologics and specialty drugs. Specialty drugs are often used to treat complex, chronic conditions, and are among the most expensive medicines on the market.
- Annual price increases of brand-name drugs that have no real competition.
While generic drugs are affordable for most people, brand-name drugs can cause serious financial pressure on most people. That’s not factoring in the fact that the cost of many popular brand-name drugs doubles every seven to eight years.
Per capita spending on specialty drugs increased by 55 % from 2015-2018 and their average cost hit $4,500 in 2018, according to a study by the American Association of Retired Persons.
According to the association’s report, brand-name medicines account for 77% of all spending on prescription drugs. The numbers are enough to make your head spin.
The answer
One way to tackle these skyrocketing prices is to increase patient access to more affordable generic or biosimilar pharmaceuticals that are approved by the Food and Drug Administration.
Using generics and biosimilars has proven to be the top way to reduce the cost of medicine outlays. For example, generic drugs can often cost 80 to 85% less than brand-name drugs, according to an analysis by the FDA. That’s usually the first option when trying to reduce a patient’s spending.
That gets more difficult when no generics exist, which is often the case for new drugs which still have their patent.
That’s where biosimilars come in. They can be affordable alternatives to expensive brand biologics, and more are coming to the market every year.
Between 2015 and 2020, the FDA approved 29 biosimilars. If the trend continues, the potential savings could reach $54 billion over the next 10 years, according to a study by the Rand Corporation.
The takeaway
The more biosimilars that come on the market, the less of a burden drug prices will be on those who need them most. Also, as more biosimilars become available, fewer people will opt for abandoning their prescriptions at the pharmacy due to cost.
In addition, when you are being prescribed drugs, you should always talk to your doctor about generic alternatives since 90% of them can be purchased for less than $20 for insured patients.
by US Rx Care | Jan 19, 2021 | Uncategorized
One of the biggest challenges for employers who offer their workers health insurance benefits is that the majority of U.S. workers are really in the dark about how insurance works, according to a new survey.
Despite employers’ best efforts to provide as much education as possible to their workers before and during open enrollment, it seems the finer points are not sinking in, according to United Healthcare’s “Consumer Sentiment Survey.”
Here are the main findings:
- A mere 7% of those surveyed had a full understanding of all four basic insurance concepts: plan premium, deductible, coinsurance and out-of-pocket maximum.
- More than 60% of respondents could define plan premium and deductible.
- 36% could define out-of-pocket maximum.
- 32% could define coinsurance.
These deficiencies result in more people spending more on coverage than they may actually need to.
Another study, carried out earlier this year by the Kaiser Family Health Foundation, concluded that not having the correct information can lead to dissatisfaction when employees discover they’ve signed up for a plan that doesn’t meet their needs.
The Kaiser survey revealed that employees are most confused when it comes to understanding these factors:
- How to calculate out-of-pocket costs once health insurance claims are processed.
- The concept of providers who are in network vs. out of network at an in-network hospital.
- Understanding deductibles and out-of-pocket annual limits for their plans.
- What a health insurance formulary is (concerning prescription coverage amounts).
What you can do
So, as open enrollment nears, you may want to consider focusing on the foregoing areas to better educate your workers. Also, it’s recommended that you approach the education process with a multi-pronged approach employing technology, meetings and the offers of one-on-one time to cater to people’s different learning styles.
It’s important for your employee morale and their pocketbooks that they understand what their choices are and what they’re buying. The more light you can shine on the process and the more stress you can reduce, the better off your employees will be.
This is especially true in light of one other finding in the United Healthcare study: One-fourth of respondents said they would rather file their annual income taxes than select a health plan.
by US Rx Care | Jan 13, 2021 | Uncategorized
Some people spend thousands of dollars a year on medications, and thanks to their insurance they may not have to pay full price for the pharmaceuticals their doctors prescribe.
But there is a growing body of drugs that are breaking the bank for insurers and the people who need them. New, innovative medicines that drug companies make using cutting-edge technology and science, can come with hefty price tags.
GoodRx.com, a website that provides coupons for purchasing prescription drugs, has published a list of the 10 most expensive drugs in the U.S. The list includes those that are available at pharmacies and ones that health care providers administer on-site.
It ranks pharmaceuticals by their annual cost for a typical course of therapy and is based on the drugs’ list prices.
The 10 most expensive drugs in the U.S., according to GoodRx, are:
- Zolgensma (Novartis) — $2,125,000. This drug is used to treat spinal muscular atrophy,a genetic disease affecting the central nervous system, peripheral nervous system, and voluntary muscle movement.
- Myalept (Amryt Pharma) — $855,678. This medication is used to treat severe metabolic abnormalities caused by leptin deficiency in people with congenital or acquired generalized lipodystrophy.
- Luxturna (Spark Therapeutics) — $850,000. This drug is a prescription gene therapy used for the treatment of patients with inherited retinal disease due to genetic mutations.
- Folotyn (Acrotech Biopharma) — $779,067. This is an anti-cancer and cancer therapy drug.
- Soliris (Alexion Pharmaceuticals) — $678,392. This drug is used to treat Grave’s disease, an immune system disorder.
- Blincyto (Amgen) — $672,968. Blinatumomab is a type of targeted cancer drug called a monoclonal antibody.
- Ravicti (Horizon Therapeutics) — $664,092. This drug is used in the treatment of certain inborn urea cycle disorders.
- Lumizyme (Sanofi) — $643,243. Lumizyme is an enzyme replacement therapy for patients with Pompe disease.
- Actimmune (Horizon Therapeutics) — $633,325. This medication is used to reduce the frequency and severity of serious infections due to chronic granulomatous disease, a genetically inherited disease.
- Takhzyro (Takeda Pharmaceuticals) — $591,035. This drug is a monoclonal antibody used to treat patients 12 years and older with types I and II hereditary angioedema.
by US Rx Care | Jan 5, 2021 | Uncategorized
With the COVID-19 pandemic weighing on employers and employees alike, businesses can help their staff by leveraging health savings accounts to pay for out-of-pocket expenses.
Congress in 2020 untethered HSAs and flexible spending accounts by changing the rules that prohibited account holders from using the funds in their accounts for over-the-counter medicines and other non-prescription health products and services. That change, which is permanent, was done through the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
HSAs are a great option to help employees save for health care expenses since all unused funds can be rolled over from year to year (there is no use it or lose it penalty). HSAs also provide the potential to build a health care savings nest egg, the funds in which can be invested so they can grow.
There is also the much-touted fact that HSAs offer a triple tax benefit:
- Contributions are not subject to federal income taxes;
- Earnings from interest and investments are tax-free; and
- Distributions to pay for qualified medical expenses are tax-free.
Additionally, people over 65 can withdraw funds for any purpose without incurring a penalty, although if not used for qualified medical expenses, they may be subject to income taxes.
Here are some tips to help your employees access HSAs:
Design a strong plan
HSAs must be tied to a high-deductible health plan and there are certain steps you can take to make them more attractive to your workers.
The HDHP plan should have a lower premium than a traditional plan in order to give your employees affordability and leftover funds to funnel into the HSA.
You can instill confidence by:
- Providing your employer contribution on the first day of the plan year to alleviate concerns about covering the deductible.
- Utilizing a Section 125 cafeteria plan to allow employees to make pre-tax salary reduction contributions.
- Putting in place a matching contribution structure to employees making salary reductions.
Educate and support your staff
Plan your HSA messaging early and way ahead of open enrollment to maximize interest. This should be a year-round educational effort that engages your staff and helps instill confidence in HSAs.
Remember, the messaging should be different depending on the age of your workers. You may need to have different approaches to educating baby boomers compared to Gen Z staff.
Help them make good decisions
You should be able to show your employees at a glance which health plans will save them money. There are tools available to do cost-benefit analyses of how much an employee spends on a health plan and if it was the most cost-effective choice.
The average employee leaves $1,500 on the able in money they could have saved on premiums had they chosen an HDHP, particularly if they don’t use health care services often.
One way to illustrate how much money they may be wasting is to provide claims-based report cards, which show whether or not they made a good choice the previous year ahead of open enrollment.
The takeaway
The goal here is to educate your workers about the power of HSAs and how having one can help them amass a substantial war chest of funds for any future expensive health care needs. If entered into early, an employee can set aside hundreds of thousands of dollars for unanticipated health care expenses.
If you provide support and education, your staff will be more engaged, resulting in them making better health care choices.
by US Rx Care | Dec 31, 2020 | Uncategorized
Part of the COVID-19 relief package that Congress passed in late December includes a notable provision that bans surprise medical bills when out-of-network doctors work on insureds at in-network hospitals.
This so-called “balance billing” occurs when an out-of-network provider is involved in a patient’s care at a hospital that accepts their insurance, often without the patient knowing about it. Patients can end up facing unexpected bills in the tens of thousands of dollars.
Specifically, the law bars out-of-network providers and air ambulance firms from billing patients for more than they would be charged by in-network providers (ground ambulance services are not covered under the law).
Additionally, health plans are barred from requiring patients to pay more for care they unknowingly receive from out-of-network providers at in-network facilities.
According to the Kaiser Foundation, 18% of emergency visits lead to at least one out-of-network charge for people covered by large group plans, as do 16% of in-network inpatient admissions.
Here are the main points of the legislation:
- The law requires that patients be billed on their plan’s in-network rate for emergency medical care at an out-of-network facility, or if they are treated by an out-of-network clinician at an in-network hospital.
- It protects patients admitted to an in-network hospital for a planned procedure when an out-of-network doctor works on the patient. Most often this happens when a doctor is called to provide assistance in the operating room, or if the anesthesiologist on duty is out of network.
- Doctors and health plans are allowed to bill for out-of-network treatment in the above situations if the patient is informed of the estimated costs at least 72 before they receive care.
- Whatever the patient pays for the above out-of-network services must be counted toward their in-network annual deductibles.
Billing disputes
For the health insurers and providers to agree on the cost of care, the new law sets up an arbitration process to settle payment disputes for out-of-network claims. The plan sponsor and the covered employee are not part of this dispute resolution process.
The law gives the insurer and provider 30 days to settle a dispute and if they can’t come to an agreement during that time, they can go to a binding arbitration process that the law creates. This “Independent Dispute Resolution” (IDR) will be administered by independent entities.
During IDR, both the insurance company and the provider submit what they want to pay to the dispute resolution arbiter, who will decide a fair amount based on what other providers charge for similar services.
The arbiter will not be allowed to consider rates paid by Medicare and Medicaid, which tend to be lower than what commercial insurers pay for services and what hospitals normally charge.
The decisions are binding. after which the insurer has 90 days to pay the bill.
The new law takes effect in January 2021.
One more thing…
Besides banning surprise billing, the law also bars gag clauses. Many contracts between health insurers and providers include provisions that bar enrollees, plan sponsors or referring providers from seeing cost and quality data on providers. These provisions will now be prohibited.
