Entrepreneur, basketball team owner, and Shark Tank star, Mark Cuban is entering the prescription drug arena, hoping to disrupt the market with low-cost medicine for the people. Cuban invested in a company called Cost Plus, and recently took the company public. The mission of Cost Plus founder Alex Oshmyansky is to provide medications cheaper to pharmacies so that they can sell meds cheaper to patients. Oshmyansky and Cuban hope to eliminate pharmacy benefit managers, the prescription medication middlemen who drive up drug prices.
The first drug Cost Plus is offering is albendazole which is used to treat hookworms which can be found in rural places in America. Typically the drug costs $225 per tablet or $450 for an entire treatment. Cost Plus can sell the drug to pharmacies at $15 per pill with a recommended markup to make the final cost to consumers, $20 per pill—significant savings to the consumer. Read more.
Source: Texas Monthly
Contrary to what many people believe, an employer asking for the vaccination status of an employee is not a HIPAA violation. HIPAA prevents an organization such as a health insurer, or medical provider from disclosing personal medical information. It does not, however, have anything to do with whether or not an employer can ask an employee about their status. Below are some examples of situations that are NOT covered by HIPAA.
Source: JD Supra
A community care network provides funding to organizations working to solve community health issues such as lack of food, that can lead to health conditions. The idea is that by supporting these community programs, the social determinants of health for a community will improve.
A solution called CureAlign works with self-insured employers to create these localized community care networks. A study by the Robert Wood Johnson Foundation saw that social determinants of health drive 80% of health outcomes. Addressing these issues and strengthening the community support network works to make the overall community healthier. Read more.
Starting on October 8, 2021, California signed a mental health mandate into law. The mandate requires that mental health and substance abuse patients be offered return appointments no more than 10 days after a previous session unless their provider approves of less frequent visits.
California has another law in place that requires patients with mental illness or substance abuse be seen within 10 days of requesting help. However, follow-up appointments for mental health are extremely hard to schedule. Therapists put the blame on insurers who don’t pay enough for them to contract with an insurance company while insurers say there is a lack of therapists. Regardless of the reason, faster access to mental health care is crucial. Read more.
Source: Kaiser Health News
South Dakota resident Barbara Kingsbury was diagnosed with cancer two years ago and her insurance plan failed to negotiate a good deal for health care with providers in her area. According to an article and research by the Wall Street Journal, hospitals often charge hospitals the highest rates when insurance doesn’t cover their medical care.
The new legislation requiring pricing transparency for hospitals went into effect on January 1, 2021, however compliance has been spotty. Insurance plans can also vary wildly from one provider to another in the rates they pay for medical services. If a plan has a weak negotiator, their customers could be paying the highest rates for procedures.
Ms. Kingsbury and her husband cashed out $90,000 of her retirement plan to pay for the mountain of medical debt from the hospital where she received her treatments. In June Ms. Kingsbury passed away with $14,000 in medical debt still hanging over her husband’s head.
Note: This is from an article in the Wall Street Journal. A subscription may be required to access the full article.
The Municipalities, Colleges, Schools Insurance Group (MCSIG) needed a solution to provide better surgery options to their 11,048 members who are employees of public schools, colleges, and municipalities. Working with care providers outside their region, MCSIG was able to leverage pre-negotiated, bundled rates including the cost of pre-and post-op care, transparent and high-quality surgical providers that offer affordable rates to their members. Read more.
For monthly Health Benefits News, opt-in to our monthly newsletter!