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Viewpoints by Craig Hasday One of the most critical components of the Employee Retirement Income Security Act of 1974 (ERISA) is the fiduciary responsibility imposed on employers and administrators managing these types of plans. Employers should be concerned. ERISA requires employers to maintain oversight of vendors and monitor pharmacy and medical costs, and the penalties for non-compliance can be severe. In fact, there have been two significant lawsuits that underscore the exposure. In both Lewandowski v. Johnson and Johnson and Navarro v. Wells Fargo & Co, a class of employers alleges damages due to a breach by their employer of …

Viewpoints from Craig Hasday There are different types of gamblers in Las Vegas. The first type sits at the slot machines and watches their money vanish with each handle pull. Sure, some win, but it’s rare and they usually give it back to the house with continued play. Then there are those that understand the game and know the odds. Since the odds are in favor of the house, these gamblers lose, but not as much and not as often. And then there are the card counters – the ones that have the data to beat the odds and mitigate …

Viewpoints from Craig Hasday In 2019, about 61% of workers with employer-sponsored insurance were enrolled in a self-insured or partially self-insured plan.* As healthcare costs rise, employers – guided by advisors like EPIC – seek cost savings by negotiating the components of health insurance premiums rather than leaving this to the opaque, and highly profitable, health insurance carriers. Plan elements, such as pharmacy costs, are routinely “carved out” and put under a microscope by sophisticated employers and their advisors. Self-insurance, however, entails assuming more risk of adverse claims. And the terms of this type of coverage are about …

… even for astute consultants, as the sleight of hand of providers increases in stealth factor. All of the constituents are seeking to maximize their share of the profits. So, new federal transparency regulations have come into play, which seek to make it clearer for payers to understand and negotiate costs. Viewpoints from Craig Hasday Transparency surrounding hospital costs went into effect on January 1, 2021, and Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates these laws, has already started sending out warning letters of non-compliance. These show just how important the providers believe it is to …

… 15.6% in 2018 and those gross drug costs escalated at a faster pace than overall healthcare spending. Factoring in rebates, the report indicates, would reduce the four-year average trend to 3.8% – and I would think this would drive costs for even 2018 below the general inflation rate. Viewpoints from Craig Hasday It wasn’t long ago that double-digit trends were the norm for healthcare, and there seemed to be no end in sight. Employers are getting used to lower increases and with the political pressure being exerted on price increases – particularly with respect to prescription drugs …