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COVID-19 Makes 2021 Medical Cost Predictions Far More Challenging

Self-insured employers typically establish “premium equivalent rates” in the third quarter of the prior year. These are an estimation of claims based upon the most recent claim data available. While these rates are used to set healthcare cost budgets, the costs that hit an organization’s income statement are based upon actual claim costs paid during the year. Several of the large public brokers predicted significant COVID-19-related costs. The EPIC financial team did not. We believed that the deferral of care would offset any pandemic claim spikes and we were right. As 2020 winds down, it is …

https://www.epicbrokers.com/insights/covid-19-makes-2021-medical-cost-predictions-far-more-challenging/

Pharmacy Update Aug 2020

FDA Rejections The Food and Drug Administration (FDA) recently rejected Gilead’s filing for approval of filgotinib for rheumatoid arthritis. With the FDA asking to see data from an ongoing clinical trial, Gilead is unlikely to be able to refile until mid-2021, pushing it further behind its competitors for the Janus Kinase (JAK) inhibitor market. These drugs suppress the immune system to prevent damage to the joints. The FDA rejected BioMarin’s Roctavian for hemophilia A. This expensive gene therapy was expected to revolutionize the treatment of this disease. However, the manufacturer will be required to complete an ongoing …

https://www.epicbrokers.com/insights/pharmacy-update-aug-2020/

There’s a Lot of Money Going to Healthcare Innovation – Will It Work?

Viewpoints from Craig Hasday Lucrative profit potential, along with political and economic pressure to reduce healthcare costs, has spawned consolidation and vertical integration of traditional insurers and pharmacy benefit managers. But costs continue to escalate, and these traditional markets will no doubt be challenged for solutions. Mergers, consolidation and innovation have combined with political agendas with multiple opinions even within the Democratic and Republican parties. Healthcare is a fragmented and inefficient industry in the United States and nearly 20% of U.S. Gross Domestic Product represents a significant opportunity for the nation’s largest companies to do it better. Walmart …

https://www.epicbrokers.com/insights/theres-a-lot-of-money-going-to-healthcare-innovation-will-it-work/

Medicare Part D Notice Requirements

Quick Facts Employers that sponsor group health plans that provide prescription drug coverage to Medicare-eligible individuals must disclose the creditable or non-creditable status of the drug coverage for the upcoming calendar year. The notices must be provided each year before October 15, which is the start date of the annual Medicare open enrollment period. Model creditable or non-creditable coverage notices are available from the Centers for Medicare & Medicaid Services (CMS). Overview The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) requires employers that offer prescription drug coverage to notify Medicare-eligible individuals as to whether …

https://www.epicbrokers.com/insights/medicare-part-d-notice-requirements/

Properly Handling Medical Loss Ratio (MLR) Rebates

Quick Facts The Affordable Care Act (ACA) requires health insurers to spend a minimum percentage of premiums on medical care, called the medical loss ratio (MLR). The minimum federal MLR standards are 80% for small group policies or 85% in the large group market. Insurers, including HMOs, must rebate (refund) any excess premiums to the policyholder by September 30 of the following year. Employers that receive MLR rebates must handle the funds in accordance with applicable plan terms and federal guidance. Background The Affordable Care Act (ACA) requires health insurers and HMOs to spend at least a certain percentage of …

https://www.epicbrokers.com/insights/properly-handling-medical-loss-ratio-mlr-rebates/

Communication Basics in a Not-So-Basic World

… excellent tools to help support your message as long as they are relevant and provide an important visual reference for your audience. Callout boxes are another effective way to visually draw attention to key points or information. Remember – plan ahead and start with the end in mind; identify what your audience needs to know, key points they need to remember, and why they should care. These things will help you prepare, design and deliver your message concisely and effectively. The EPIC Communications & Engagement team works closely with our clients to help make meaningful, engaging employee communications. Check out our recent

https://www.epicbrokers.com/insights/communication-basics-in-a-not-so-basic-world/

Covering Coronavirus: Risk Considerations Volume 1, Issue 21

EPIC Risk Advisory Bulletin Volume 1, Issue 21 In this issue, we take a focused look at: Supply Chain and Business Risks FMCSA Extends Emergency Declaration Insurance Products and Coverage Information Business Interruption Update PPP Loans: What’s Next? News of Note Human Resources and Employee Benefits Contact Tracing: Considerations for Employers Remote Workplace Investigations Temporary Cal/OSHA Change: CA Mask Shortage Benefit Program Renewals: Looking Ahead Workers’ Compensation Webinar Presumptive Compensability Legislation Update Insights from Across the Firm The information presented here is intended to provide a high level overview of critical areas of concern for businesses around coronavirus …

https://www.epicbrokers.com/insights/covering-coronavirus-risk-considerations-volume-1-issue-21/

Brace Yourself for More from the Opioid Addiction Crisis

Just as the first cases of coronavirus (COVID-19) made their way into New York City in March, I wrote about efforts made by dental insurers and medical carriers to address the opioid epidemic in our country. The COVID-19 pandemic started tearing its way through the world soon after. Flash forward to summer, when the Centers for Disease Control and Prevention (CDC) reported nearly 71,000 American drug overdose deaths in 2019 according to preliminary data – a new record that predates the COVID-19 crisis and was primarily driven by fentanyl, other synthetic opioids, cocaine and methamphetamine. For more …

https://www.epicbrokers.com/insights/brace-yourself-for-more-from-the-opioid-addiction-crisis/