Pharmacy Benefit Managers (PBMs) Under Fire in Washington For years lawmakers have aimed criticism at pharmaceutical companies for the increasing costs of medications in the United States. However, the cost of prescriptions lies in the lap of three of the largest pharmacy benefit managers (PBMs), OptumRx, Caremark, and Express Scripts. These PBMs also happen to […]

Facility Fees Blindsiding Patients Facility fees are charged by hospitals and provider groups even when patients aren’t visiting the facility. Some states, including Connecticut and Colorado, have either already limited facility fees or are considering it. Hospitals argue that the fees are necessary to stay open as these fees typically help with the cost of […]

Humana Leaves Employer Insurance Market Humana has decided to leave the employer insurance market and focus instead on its government programs including its Medicare Advantage plans and specialty segments. Humana’s Medicare Advantage plans increased this year and are expected to continue to rise prompting the company to focus its resources on increasing that line of […]

Amazon Discount Drugs Program to Launch Amazon continued its road into healthcare when it created a discount drug program for Prime members. The program is a subscription service that allows Prime members to fill as many prescriptions as needed for $5 per month. The prescriptions are, of course, delivered to their doorstep. Amazon already sells […]

Employer-Provided Health Care is Increasingly Unaffordable More than six in 10 adults reported obtaining their health care through their employers. However, out-of-pocket costs have continued to rise over the years which has made health care increasingly unaffordable. A CDC-sponsored study revealed that on average, women had less affordable health care services than men. A reason […]

Anthem (Elevance) Sued for Alleged ERISA Violations A class action lawsuit has been filed against Anthem (now known as Elevance) claiming that ERISA was violated when Anthem “denied plan claims access due to mismanagement of funds.” The plaintiff claims that Anthem breached ERISA when it denied them access to their plan claim data, which Anthem […]

Open Enrollment Improvements in 4 Steps Open enrollment can be a confusing time for your employees. The key to a successful open enrollment is communication. From increasing and varying your types of communication to leveraging your team to create discussion, there are ways you can increase employee understanding and participation. Invest in health care literacy. […]

Long Covid Coverage for Health Plans Nearly 24 million adults in the United States have long Covid. Of those, 2-4 million are not working because of the disease. Because there is still much to be learned about long Covid, diagnostic and treatment options still need to be clarified. This can leave insurers in a sticky […]

Cancer Care Out-of-Pocket Costs Keep Rising A study published in the Journal of the National Cancer Institute found that people with cancer under age 65 are paying more out-of-pocket for their treatments. The study focused on four of the most common cancers including breast, colon, lung, and prostate cancer. The study found that as the […]

How the Inflation Reduction Act Could Affect Employers The Inflation Reduction Act (IRA) passed on August 16 of this year could have some effect on employers that companies should keep in mind in the coming years. Areas affected include prescription drug costs, insulin uses, expansion of ACA subsidies, individual coverage health reimbursement arrangements (ICHRAs), and […]