Hot Topics Blog
Thursday, July 27 2017
For small businesses with less than 5 employees in western Washington state, buying health insurance inside the more stable group insurance marketplace will be a challenge, but one which needs facing for 2018.
Wednesday, July 19 2017
Back in the late eighties, for every dollar spent on medicine, roughly 12 cents went towards prescription drugs. Fast forward to the present, and you’ll find that number has increased to a whopping 38 cents, with pharmacy trend expected to continue rising at 15%-25% annually.
Consider this: there are 6 new Specialty maintenance drugs (not cures, maintenance drugs) slated for release before the end of 2016, each carrying a 6 figure price tag. How did Specialty Pharmacy become such a trend-inflating monster? Why is the use of these medication types skyrocketing? To find some of the answers, we need to look no further than our home TV.
We’ve all seen the Specialty medication commercials …you know, the ones that endlessly drone on between the nightly news segments. But, did you know only the U.S. and New Zealand allow DTC (Direct to Consumer) drug ads? It appears the FCC will continue to allow Big Pharma to use their sneaky commercials to solicit and entice us to run to our doctors and ask for these new, amazing medications by name. But these commercials and their drugs come at a price... a big one for group health plans!
So what is feeding this pervasive Specialty drug trend? The top 3 specialty therapy classes include medications for multiple sclerosis, oncology and inflammatory conditions. Just these three 3 classes alone accounted for 56.3% of the entire specialty medication spend in 2015. Let’s take a look at the top 10 specialty therapy classes for 2015:
Source: American Journal of Pharmacy Benefits, Published online March 16, 2016. www.ajpb.com
Most large, self-insured employers (2,000+ employees) enjoy having the option to carve-out prescription drug costs away from their medical plan and contract directly with the PBM (Pharmacy Benefit Manager) itself, resulting in increased transparency and a potential for large cost savings. But, what if you are a smaller self-insured employer, say around 250 employees? I can’t help but wonder what price that health plan is currently paying for Specialty and other drugs.
The truth is, the large PBMs won’t even pick up the phone and speak with a smaller employer, because the PBMs pricing and servicing bandwidth just isn’t cost favorable for this segment. That is until recently.
At PNW Insurance Solutions, we approach pharmacy claims for smaller employers as something to be managed, as part of a multi-year strategy. If you are a smaller employer, you can have options too, you just need to know the right insurance advisor who can provide them. Faced with double-digit increases in health care costs and premiums, many driven by high cost specialty medications, smaller employers between 100-1,999 lives want and need solutions too! Fortunately, PNW Insurance Solutions has an established process to provide PBM carve out analysis to the underserved smaller, group employer segment.
You have options!
Sunday, July 16 2017
Benefits Begin January 1, 2020
Washington has enacted a paid family and medical leave law. Highlights of the law are presented below.
Definitions of 'Family' and 'Medical' Leave and Maximum Duration
"Medical leave" means any leave taken by an employee from work made necessary by the employee's own serious health condition.
The maximum duration of paid family leave may not exceed 12 times the typical workweek hours during a period of 52 consecutive calendar weeks. The maximum duration of paid medical leave may not exceed 12 times the typical workweek hours during a period of 52 consecutive calendar weeks. Paid medical leave may also be extended an additional 2 times the typical workweek hours if the employee experiences a serious health condition with a pregnancy that results in incapacity.
Coverage, Eligibility, and Benefit Start Date
Beginning January 1, 2020, family and medical leave are available and benefits are payable to a qualified employee. Following a waiting period consisting of the first 7 calendar days of leave, benefits are payable when family or medical leave is required. However, no waiting period is required for leave for the birth or placement of a child.
The maximum weekly benefit for state family and medical leave that occurs on or after January 1, 2020 is expected to be $1,000. By September 30, 2020 (and by each subsequent September 30th), the state is expected to adjust the maximum weekly benefit amount to 90% of the state average weekly wage. The adjusted maximum weekly benefit amount is expected to take effect on the following January 1st.
The minimum weekly benefit is not expected to be less than $100 per week, except that if the employee's average weekly wage at the time of family and medical leave is less than $100 per week, the weekly benefit will be the employee's full wage.
Notice, Posting, and Recordkeeping Requirements
Each employer must also post and keep posted—in conspicuous places on the employer's premises where notices to employees and applicants are customarily posted—a notice (to be prepared or approved by the commissioner) setting forth excerpts from, or summaries of, the pertinent provisions of the law and information pertaining to the filing of a complaint.
Additionally, an employer must keep at the employer's place of business a record of employment, for a period of 6 years.
Beginning January 1, 2020, family and medical leave are available and benefits are payable to a qualified employee; however, the law contains various effective and applicability dates. Affected employers with questions about the law's impact on workplace policies and practices should contact a knowledgeable employment law attorney.
Click here to read the text of the law.
Wednesday, July 05 2017