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PBM Evaluation Challenges
Category:
Employee Benefits & Strategies
Published:
January 8, 2020
Why is it so difficult to determine the value of one self-insured carve out PBM offering versus another? This isn’t a life riddle or a large-scale socio-economic question. It’s a math problem. As such, it should merely require the application of mathematical theorems that have existed for thousands of years to determine th... read more
Burnout: The Latest Major Health Crisis to Affect the Workplace
Category:
Mental Health / Depression
Published:
January 2, 2020
Why is burnout important?
Burnout has been identified as a major health crisis in the U.S. workforce, leading to reduced job engagement, lower productivity, more frequent or extended sick leave, occupational change and even permanent withdrawal from work. Recent studies have found more than 1 in 5 workers experience feelings o... read more
Know Your Numbers 2.0
Category:
Wellness / Employee Well-being
Published:
December 6, 2019
It’s hard to believe that the initial Know Your Numbers initiative was launched nearly 10 years ago to help employee benefits and HR professionals assist employees and other plan participants in managing their health and well-being with an easy to implement tool. While technology has progressed through the advent o... read more
Medical Marijuana & Employers A Clinical Dive Before Cannabis Can be Covered
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
December 5, 2019
As medical marijuana continues to gain approval at the state level, many questions arise regarding its safety and efficacy. Does scientific evidence support the use of medical marijuana? Should it be considered as a medication for certain disease states, and therefore, a covered benefit? This popular topic poses many challenge... read more
Flu Vaccine Infographic
Category:
Wellness / Employee Well-being
Published:
September 12, 2019
Why should people get the flu vaccine?
Lowers the risk of catching the flu in the first place.
Lessens the severity of the flu even if you do catch it.
Reduces lost work time, doctor visits, subsequent hospitalizations and even death.
Contributes to immunity in the overall community, which helps protect those who can’t get ... read more
Employee Assistance Program Infographic
Category:
Survey
Published:
August 16, 2019
Employers Health recently surveyed its membership to gain insight on Employee Assistance Program (EAP) usage. More than 90% of employers responding offer an EAP. Approximately 5% do not offer an EAP and two respondents stated they do not currently, but plan to in the future. Download the document to find out more!
read more
Rheumatoid Arthritis Painful for the Patients and Payers
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
May 21, 2019
When reviewing therapeutic classes by cost, rheumatoid arthritis (RA) will likely sit at the top of pharmacy benefit spend for a plan sponsor. The inflammatory condition is also one of the leading causes of disability since RA patients are seven times more likely to reduce work hours. They are also six times more likely to inc... read more
The Growing Gap Between List and Net Prices of Drugs
Category:
Employee Benefits & Strategies
Published:
May 21, 2019
The gap between list and net prices of drugs has been growing at a rate that many pundits have long speculated is unsustainable. Specifically, the steady increase in unit costs of branded medications and the presence of ever-increasing available rebates has created a significant gap between the list price and the “true” co... read more
Financial Health Shutdowns, Snowballs and Sages
Category:
Employee Benefits & Strategies
Published:
May 17, 2019
What do shutdowns, snowballs and sages all have in common? Sounds like the beginning of a bad joke. The answer may surprise you as all three have to do with different aspects of financial health. In our country where indebtedness is the norm, the national debt in the United States just passed the $22 trillion mark1, savings ar... read more
7 Tips to a Healthier, Happier You at Work
Category:
Wellness / Employee Well-being
Published:
April 5, 2019
Work can be stressful. Add the increasing pace at which life and family obligations come at us and even the most laid-back person can get stressed from time-to-time. We’ve listed seven quick and easy tips to help you and your employees stay relaxed and stress free at work. Feel free to print these tips, share them with a cow... read more
What Does the New HHS Rule Mean for Employers?
Category:
Employee Benefits & Strategies
Published:
February 15, 2019
The U.S. Department of Health & Human Services requested comment on a proposed rule that removes the current safe harbor protections for rebates involving prescription pharmaceuticals from the Federal anti-kickback statute and creates two new safe harbor protections for certain point-of-sale discounts and certain PBM servi... read more
2019 Market Check
Category:
Employee Benefits & Strategies
Published:
November 30, 2018
The pharmacy benefit management marketplace is facing more public scrutiny than ever. Over the past several months, the news media exploded with stories concerning the business practices of pharmacy benefit managers (PBMs). Some stories focus on the rebates PBMs receive from drug manufacturers or the unexplained spikes in the ... read more
In the News: Clawbacks, Gag Orders and Other Painful Sounding PBM News
Category:
Employee Benefits & Strategies
Published:
November 30, 2018
It seems on a weekly basis that publications introduce us to some new term that describes an unruly practice within the pharmacy benefit landscape. Clawbacks, spread, gag clauses and others dominate the headlines, with advocates for the many stakeholders in the pharmacy supply chain lining up to either launch an assault or def... read more
Preparing Workforces for Demanding Environments
Category:
Wellness / Employee Well-being
Published:
November 30, 2018
Does your industry include workers who operate in highly demanding environments? For example, health care, construction, law enforcement, counseling and social work professions have both predictable and unpredictable threats, pressures, and circumstances that create high levels of cumulative stress. Increasingly, one unpredict... read more
The Countdown to NASH: Employers Brace for the New Non-Specialty Condition
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
November 20, 2018
In recent years, the health care world was heavily focused on developing and finding a cure for hepatitis C, a bloodborne infection affecting nearly 3.9 million people in the U.S.1 With the advent of therapies with cure rates more than 90 percent for hepatitis C, medical professionals now predict a shift in industry focus to t... read more
Beyond the Spreadsheet: PBM Pricing Tips Part 1
Category:
Employee Benefits & Strategies
Published:
November 7, 2018
There are quite a few PBM pricing “illusions” that require purchasers and their consultants to look “beyond the spreadsheet.” These subtle caveats are aimed at providing the illusion of more aggressive pricing through higher discounts and rebates on the consultant’s spreadsheet while reducing or changing the number o... read more
2018 Flu Vaccine Info
Category:
Wellness / Employee Well-being
Published:
September 12, 2018
Protect your employees and workplace from the flu! Check out this infographic and share it with your employees to learn:
Why people should get the flu vaccine
How the vaccine works
How you can protect your employees and workplace
Who should get vaccinated and more
read more
Continuing to Consolidate: Health Care Mergers & Acquisitions
Category:
Employee Benefits & Strategies
Published:
August 9, 2018
Edited 10/12/18
With prescription drug prices rising, the spotlight is shining brightly on the health care industry. Consumers and politicians alike have questioned how best to curtail rising prices. Consolidation is a central strategy of managed care organizations, pharmacy benefits managers, pharmacies, wholesalers and insur... read more
Where Policy Meets Culture: Aligning for Mental Health at Work
Category:
Mental Health / Depression
Published:
August 9, 2018
Change is hard, and many benefits professionals may not feel empowered or equipped with the resources needed to be on the cutting edge of adopting and implementing innovations. Benefits professionals routinely ask:
Who else is doing “it”?
What exactly are others doing?
What results are those other employers experiencing?
... read more
Migraine Meds: An Employer’s Next Big Headache in Drug Spend
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
August 9, 2018
In 2014, it was hepatitis C drugs while 2015 brought us PCSK9 inhibitors. Could 2018 be the “blockbuster” year of calcitonin gene-related peptide (CGRP) inhibitors for migraines? As was the case with those previous therapies, CGRP drug uptake will depend on a plan sponsor’s population and how efficiently the class is man... read more
In-Focus: A Snapshot of the Pharmacy Benefit Industry
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
November 15, 2017
The pharmacy benefit marketplace has been at the center of attention lately due to a combination of factors, including the growing list price of brand medications and the impact their prices have on the participant, particularly those enrolled in high deductible health plans. The outrage over Mylan’s price inflation of its E... read more
Coming Soon: Million Dollar Drugs – How can employers prepare for gene therapies?
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
November 8, 2017
A new age of medicine is upon us, and it comes in the form of personalized gene therapy. Recent developments have pushed the single-dose, potentially curative treatments with high projected price tags closer to launch. Thus, the benefit design and coverage for engineered genes to treat, prevent and cure diseases are a rapidly ... read more
The American Health Care Act and Beyond
Category:
Health Care Reform
Published:
June 1, 2017
The Trump Administration and Republican controlled Congress have begun an attempt to advance certain objectives that have become dogmas during the election.
One such objective is to repeal and/or replace the Affordable Care Act (ACA). Unlike prior GOP efforts related to funding restrictions and legal challenges that were met w... read more
2017 Excellence in Benefits Award Winner
Category:
Employers Health News
Published:
May 25, 2017
Employers Health, a professional benefits organization, is announcing the first-ever recipient of its Excellence in Benefits Award. The award is intended to recognize annually, an individual who has made meaningful impact in the field and/or delivery of employee benefits.
This year’s winner is Jessica Ward, benefits manager ... read more
What is the Deal With Drug Price Inflation
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
May 4, 2017
Providing affordable and sustainable benefits is a primary goal for employers that offer prescription drug coverage. Recent press and public scrutiny over rapidly rising drug prices has revealed the struggle many plan sponsors experience in their efforts to achieve that goal. It is not a secret that annual drug price inflation... read more
A collaborative benefits management strategy for total population health
Category:
Employee Benefits & Strategies
Published:
January 5, 2017
Benefits Accelerator® is a value-based strategy that harnesses a robust technology platform, preferred vendors with proven concepts and results that emphasize heightened health status and well-being. This collaborative approach can accelerate a plan sponsor’s objectives to control health care costs, improve health outcomes ... read more
Recent Wellness Program Regulations: ADA & GINA
Category:
Compliance / Reporting
Published:
December 1, 2016
As plan sponsors prepare for open enrollment, attention should be given to the Equal Employment Opportunity Commission’s (EEOC) new wellness regulations under the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA). With final rules, released May 16, 2016, regarding notice and finan... read more
Biosimilar Basics for Plan Sponsors
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
November 16, 2016
The rise of specialty pharmacy spend and trend can be traced back to the work of pharmaceutical manufacturers determined to provide targeted biological treatment for complex medical conditions. We must now count on these same manufacturers to create the competition necessary to provide these innovative treatments in an afforda... read more
Tailor-Made: Uniquely Personal Well-Being
Category:
Wellness / Employee Well-being
Published:
October 8, 2016
The saying goes “sometimes you have to go back to the beginning in order to move forward.” The well-being industry progresses from one trend to the next with new vendors constantly emerging with the latest and greatest unproven solution, claiming this is the one to transform the health of your workforce or build your cultu... read more
Healthy Organizations Creating Well Workforces
Category:
Wellness / Employee Well-being
Published:
May 5, 2016
The link between workforce health and a healthy organizational bottom line has been repeatedly made through research. According to one study, companies with high employee engagement had a 19 percent increase in operating income and nearly a 28 percent growth in earnings per share.
read more
ACA Employer Mandate and ERISA Implications
Category:
Compliance / Reporting
Published:
May 4, 2016
Many in the legal community warned of possible Employee Retirement Income Security Act of 1974 (“ERISA”) implications and litigation risk surrounding scheduling decisions made by employers in order to avoid being subjected to an Affordable Care Act (“ACA”) penalty for failure to offer coverage to full-time employees.
read more
Why is My PBM Pushing a Multi-Year Pricing Contract?
Category:
Employee Benefits & Strategies
Published:
April 5, 2016
Most plan sponsors evaluate the pricing competitiveness of their pharmacy program the same way – by going out to bid for a new pharmacy benefits manager (PBM). But, running a bid process can be expensive and difficult to manage. Therefore, plan sponsors tend to avoid the process all together. PBMs use this to their advantage... read more
EH Pharmacy Trend Less Than 1% in 2015
Category:
Employers Health News
Published:
April 3, 2016
For 2015, clients in the Employers Health pharmacy benefit management (PBM) solution experienced an overall average per member per year (PMPY) cost trend of nine-tenths of one percent. While drug price inflation, utilization of expensive specialty medications to treat diseases such as hepatitis C and greater utilization increa... read more
The Impact of Opioid Addiction to Plan Sponsors
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
March 4, 2016
Car crashes are no longer the leading cause of injury death in the United States. That morbidly-esteemed title now belongs to overdose deaths due to opioids either by prescription or heroin that claims the lives of seventy-eight Americans daily. The abuse and overprescribing of opioid analgesics is an epidemic that requires al... read more
Survey Says Employers Continue Efforts to Reduce Health Benefit Costs
Category:
Employee Benefits & Strategies
Published:
March 3, 2016
The “Cadillac Tax” is a 40 percent excise tax on the cost of employer-sponsored health coverage that exceeded certain cost thresholds. As originally enacted by the Affordable Care Act (“ACA”), the Cadillac Tax was non-deductible and scheduled to begin in 2018. Although the tax was intended to only impact “high-cost... read more
Nominate an Outstanding Benefits Professional Today
Category:
Employers Health News
Published:
January 3, 2016
Employers Health, a professional benefits organization, is currently accepting nominations for the Excellence in Benefits Award. The award seeks to recognize an individual annually who has made meaningful impact in the field and/or delivery of employee benefits. Nominations for the award will be accepted now through January 31... read more
Cultures of Health and Engagement – Small Steps, Big Rewards
Category:
Wellness / Employee Well-being
Published:
November 1, 2015
Organizations commit millions of dollars each year to designing the optimal compensation and benefits packages for their workforces. They spend considerable resources providing perks to attract and retain high-performing employees in their marketplaces. Top talent is hired to lead the charge, forming strong human resource and ... read more
2015 Fall Medication Approval and Strategy Update
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
October 10, 2015
Employers Health is pleased to provide this seasonal medication update! the goal of this piece is to inform our members about the latest pharmaceutical industry news relevant to employers while providing analyses and strategies to best manage these trends. Please send any questions or comments to our clinical pharmacist, Matth... read more
PBM Annual Market Check
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
September 15, 2015
Member organizations that participate in an Employers Health PBM program enjoy an uncommon feature known as an annual “Market Check.” What is the Market Check and what role does it play in delivering value to plan sponsors?
Customary PBM Contracts
The pharmaceutical marketplace is dynamic. However, most agreements between... read more
ACA Reporting – How are employers managing the new requirements?
Category:
Compliance / Reporting
Published:
August 3, 2015
In a recent survey completed by Employers Health, 32 percent of employers reported their organizations were unprepared for the Sections 6055 and 6056 reporting requirements under the ACA.
For large, self-insured employers, not only are these requirements burdensome, with an estimated time of 12 minutes to complete each Form 10... read more
Managing the Complexity of Specialty Pharmacy Benefits
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
May 13, 2015
Defining specialty
Specialty drugs do not have a consensus definition across all stakeholders in the specialty space, but they can generally be thought of as high-cost medications used to treat complex conditions. Often, these medications are biologically developed from a living organism into products such as hormones, protein... read more
Cancer as a Chronic Condition
Category:
Cancer / Oncology Benefits
Published:
May 10, 2015
In the past several years, cancer has become an important focus for employers, for a number of reasons. Perhaps most significant is the fact that an increasing number of cancers are being identified in the workforce.
Better diagnostic testing, elimination of patient financial barriers to cancer screening, and an aging workforc... read more
Depression: The Unexpected Threat to Your Company
Category:
Mental Health / Depression
Published:
May 4, 2015
As a first-of-its-kind initiative, Right Direction has received national attention for its leadership in addressing depression in the workplace. To validate the societal and economic burden of how depression impacts employers, Employers Health launched the results of The Impact of Depression at Work Audit (IDeA)* survey (Ipsos... read more
Recent Wellness Program Litigation and the Cadillac Tax
Category:
Compliance / Reporting
Published:
April 1, 2015
As plan sponsors grapple with rising claims cost, many have turned to wellness programs to not only reduce costs, but also to improve the well-being of their plan participants. With the impending Cadillac Tax threatening a 40 percent excise tax on high-cost health coverage, wellness programs could be a key element in plan spon... read more
Female Libido Drug Raises Clinical and Legal Considerations
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
January 4, 2015
With the recent approval of Addyi (flibanserin) for the sudden and unexplained loss of libido for premenopausal women, plan sponsors must weigh clinical and legal considerations. There are very important questions over Addyi’s low efficacy, concerning side effects, and the potential for gender discrimination. From a clinical... read more
Clocked In, Checked Out
Category:
Mental Health / Depression
Published:
December 2, 2014
Numerous studies have illustrated the cost of unhealthy workers to their employers in terms of increased medical, pharmacy and disability claims. In 2006, more than $2 trillion was spent on health care with three fourths of that amount focused on treating chronic conditions (Goetzel, 2009). Research in abundance demonstrates n... read more
Understanding the Hepatitis C Virus and its Impact on Employers
Category:
Pharmacy Benefits / Specialty Pharmacy
Published:
October 4, 2014
Making it the most common chronic bloodborne infection in the US, an estimated 3.2 million people are impacted by the Hepatitis C virus (HCV). Many are concerned about the approved HCV medications and high-cost therapies. To better understand the benefit implications of HCV, it is important to grasp the risk factors and clinic... read more
Obesity in the Workplace
Category:
Obesity
Published:
October 4, 2014
Are you doing all you can to combat this disease? The American Medical Association (AMA) defines a disease as an impairment of the normal functioning of some aspect of the body, with characteristic signs and symptoms that result in harm or morbidity to the entity affected. In June 2013, the AMA officially declared obesity a di... read more
Thinking About a Private Exchange? Here are some helpful considerations when making a selection
Category:
Employee Benefits & Strategies
Published:
September 3, 2014
Over the past 10 years, employer expenditures for employee health care were perceived as a “necessary evil,” as employers used health benefits as part of their attraction and retention strategies. With health care costs rising faster than the general inflation rate, employers and plan sponsors have been faced with the chal... read more
IRC Section 6055 and 6056 Reporting: Fast Facts
Category:
Compliance / Reporting
Published:
September 3, 2014
Applicable large employers (“ALE”) and employers who provide minimum essential coverage will have to file additional tax forms in 2016 for the 2015 plan year. Listed here is a brief overview of the information that employers and plan sponsors will be required to provide.
6055:
• Name, address and EIN of the plan sponsor... read more
Total Well-being: Moving Past the Physical Domain
Category:
Wellness / Employee Well-being
Published:
April 1, 2014
In a recent Employee Benefits News article, Jeffrey Pfeffer, a professor of organizational behavior at Stanford University’s graduate school of business, was quoted at the annual Great Place to Work conference in New Orleans as saying, “Health and wellness programs are virtually meaningless if a workplace culture is bad.... read more
The Importance of Immunization
Category:
Wellness / Employee Well-being
Published:
September 13, 2013
Since the creation of the smallpox vaccine over two hundred years ago, immunization from viruses has been one of the most cost-effective strategies to protect the public from illness. From polio to tuberculosis, many of the world’s once-feared diseases have been eradicated or substantially weakened due to the ability of a va... read more
Moving Beyond Biometrics
Category:
Obesity
Published:
April 11, 2013
To date, many corporate wellness programs have been created with the Biomedical Model at their foundation. This conceptual model of illness which excludes psychological and social factors and includes only biologic factors in an attempt to understand a person’s medical illness or disorder (Stedman’s Medical Dictionary, 201... read more