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In 2018, Efforts to Lower Medical and Drug Costs
Client Update by Michael S. Grant
It’s no secret that the costs of medical and pharmaceutical care are so inflated, they are untenable expenses for many Americans, causing them to delay or altogether avoid receiving the medical care they need to prevent or manage illness. In 2018, we will see increased efforts to create price transparency and fairness to lower costs for consumers.
Another Move by an Insurer to Reduce Drug Costs, This Time It’s Aetna
In last month’s issue we noted various moves by health insurers that are affecting the health care industry. One of those being that on March 6, 2018, UnitedHealthcare announced it will be expanding pharmacy discounts to over 7 million group health plan consumers when they fill prescriptions through their retail pharmacies or home delivery. The savings will come from manufacturer drug rebates being applied at the time of purchase, rather than through lower plan premiums.
Later in the month, Aetna announced a similar decision that will affect about 3 million of its members, which will be implemented in 2019.
These types of decisions reflect the changing health insurance industry. As health insurers merge with pharmacy benefit managers to become one large entity (perhaps, in part, a defensive move against Amazon.com Inc.’s potential entrance into the health insurance market), middle man costs are removed and insurers are more inclined to pass savings to the consumer. These moves also serve to respond to consumer complaints of rising drug costs.
LEGISLATION & REGULATION
Don’t Forget! San Francisco Employers Must File HCSO Reports by April 30, 2018
The San Francisco Health Care Security Ordinance (HCSO) requires covered employers to satisfy the Employer Spending Requirement (ESR) and file reports with the Office of Labor Standards Enforcement (OLSE) on an annual basis. These reports are due by April 30 of each year. The online reporting form, and more information about this ordinance, is available on the OLSE website.
New Rules for Disability Benefit Claims, Effective April 1, 2018
Effective April 1, 2018, ERISA employee benefit plans that include disability benefits must comply with new procedural protections, effective for disability claims that are submitted after April 1, 2018, regardless of the date of disability.
Entities that administer disability benefit claims, including issuers and third-part administrators, will need to revise their claims procedures to comply with the final rule.
Massachusetts Pregnant Workers Fairness Act, Effective April 1, 2018
The federal Pregnancy Discrimination Act prohibits employers with 15 or more employers from discriminating against individuals based on pregnancy or related medical conditions. Massachusetts has enacted a similar law that applies to a broader range of employers in the state.
Effective April 1, 2018, Massachusetts’ Pregnant Workers Fairness Act (PWFA) requires Massachusetts employers that have six or more employees to provide reasonable accommodation for their employees’ pregnancies or pregnancy-related conditions upon request, unless it would cause undue hardship. The law also prohibits these employers from discriminating against employees and applicants based on pregnancy or related conditions.
More State Legislative Changes
Effective until Jan. 1, 2020, the California Department of Fair Employment and Housing is testing a mediation pilot program for complaints filed under the parental leave law that took effect Jan. 1, 2018.
On February 11, 2018, the Maryland Healthy Working Families Act went into effect.
All employers with employees whose primary work location is in Maryland are required to provide earned sick and safe leave, regardless of where the employer is located. Employers who employ 15 or more employees are required to provide paid earned safe and sick leave. Employers with 14 or fewer employees are required to provide unpaid earned sick and safe leave.
Plan provisions regarding coverage for Rx drugs are revised for provider contracts effective January 1, 2019, including: plans that provide coverage for Rx drugs can’t deny coverage for drugs that are prescribed to treat a covered indication so long as the drugs are approved by the FDA to treat the covered indication. Additional provisions include coverage of cancer medications, formularies, pharmacy choice and pharmacy ID cards.
- It’s now a misdemeanor for an employer to discriminate in providing compensation based on the gender of a similarly employed employee.
- Expansion of contraceptive drug coverage, including: Plans that provide coverage for Rx drugs must provide coverage for Rx contraceptive drugs and devices approved by the FDA.
- Expansion of maternity services: Plans that provide coverage for maternity services must permit the doctor and mother to make decisions on length of inpatient stays following childbirth and must provide substantially equivalent coverage for abortions.
- Plans must provide coverage without imposing cost-sharing requirements for various preventive health services.
Read about these and other recent changes to state benefit mandates, unemployment insurance, and more, affecting California, Delaware, Illinois, Iowa, Maryland, Massachusetts, Michigan, Nebraska, Nevada, New Jersey, South Dakota, Virginia, Washington, West Virginia and Wyoming.
In case you missed it, here’s more news from our other insurance sectors at Crystal & Company:
Own multiple properties? In If You Own Many Properties, You Likely Have Too Many Insurance Policies, Diane Ciaccia discusses how real estate investors can save time and money by combining individual property insurance policies into one master policy.
In The Perils of New Energy Workers, David House and Steven Langlinais examine the safety concerns raised by the energy industry’s recent spike in hiring.
Check out more thought-provoking commentary at www.crystalco.com/thought-leadership/