Group Benefit Services, Inc. Blog

Group Benefit Services, Inc. Bloghttp://www.gbsitpa.com/blog/View Group Benefit Services, Inc.'s Website Blogen-uspostmaster@www.gbsitpa.comInsurance Website Builder - www.insurancewebsitebuilder.comurn:uuid:f95d034d-da3d-40c4-8ec1-56c77e5031e9urn:uuid:fbb83e7b-0e0d-4610-b948-f13444f2b3b9The Impact of Rx Adherence on Health Care Plans!The Impact of Rx Adherence on Health Care Plans! By: James M. Deren Patients who are adherent in taking their prescription medications spend significantly less money on total healthcare costs than their counterparts. In fact, adherence to drug the...Wed, 14 Sep 2011 10:10:08 -0500The Impact of Rx Adherence on Health Care Plans! By: James M. Deren Patients who are adherent in taking their prescription medications spend significantly less money on total healthcare costs than their counterparts. In fact, adherence to drug therapies reduces increased pharmacy costs by 13 to 1 (CVS Caremark, 2011). Below are some examples of several Per Member Per Year (PMPY) savings categories (Reuters & CVS Caremark, 2011):  Savings  Chronic Condition  $7,823 –  Congestive Heart Failure $3,908 –  Hypertension $3,756 –  Diabetes $1,258 –  Dyslipidemia  Finding ways to help increase drug therapy adherence through proper plan design is extremely important. It lowers medical costs, increases overall job performance, and job productivity. Therefore, making it easy for plan members to access their maintenance prescriptions such as heart medication, high blood pressure, and diabetes—saves<s> </s>money on over all healthcare costs.  Plan members normally fill maintenance prescription drugs 30 days at a time. The cost basis for these drugs through the health plan is known as “Average Wholesale Price” (AWP). Most of the 30-day supply medications’ drug costs are approximately AWP -19 to -22 percent (19 to 22 percent below wholesale price) depending on how the Pharmacy Benefit Manager (PBM) contract is structured. However, a health plan can purchase a 90-day supply of the same generic medications at an AWP of -40 to -70 percent. That is, a health plan can save about 30 to 80 percent of its prescription drug cost by simply structuring the pharmacy program for the plan members to purchase their generic medications on a 90-day at a time rather than a 30-day brand supply. In order for employers to yield savings on drug costs, the contractual ingredients must exist between the employer’s health plan and the PBM. PBM’s pay fewer rebates on mail order prescriptions than on retail prescriptions, which means employers can spend less on the mail order “type” prescriptions if the proper incentives exist for plan members. Insurance companies rely on plan members filling their prescriptions on a 30-day supply to generate healthy rebates for the insurance companies. Group Benefit Services (GBS) has an arrangement and the contractual ingredients with our PBM’s that allows plan members to access a 90-day supply of maintenance drugs directly from a pharmacy in lieu of the mail order program, while employers yield similar savings mentioned herein for the 90-day supply. Proper plan design will not only save the plan and its members money by purchasing the maintenance drugs in this manner but also make it easier for the plan members to be adherent to their drug therapies as well as saving the employer money on its overall healthcare dollars. At GBS, we “partner” with employers to develop health plans and strategies that meet their specific goals. We also educate our clients’ plan members on how to access the programs that will save them money and enhance their health and wellness. It would be an honor to have the opportunity to provide a detailed proposal and show you how these programs can assist your members and save your health plan money. urn:uuid:a904debc-fa08-401b-889e-912b90c0fd22Employers streamlining benefit - saving time & money! Employers streamlining benefit - saving time & money! By: James M. Deren Employers have long dealt with shopping a variety of their employee benefit coverage’s (Medical, Dental, Vision, Life, and Disability) to save money only to be lef...Thu, 28 Jul 2011 12:46:30 -0500 Employers streamlining benefit - saving time & money! By: James M. Deren Employers have long dealt with shopping a variety of their employee benefit coverage’s (Medical, Dental, Vision, Life, and Disability) to save money only to be left with a very cumbersome enrollment process.  When shopping the available insurance markets to get the best price, the employer will end up completing enrollment forms for each line of coverage with each insurance carrier. Employers that do not shop the different lines of employee benefit coverage may be forced to place all of their insurance with one or two carriers which sacrifices competitive pricing in order to have an enrollment process that is less tedious.  Having all coverage with one carrier is not a guarantee that the paperwork will be simplified and there certainly is not a guarantee that the rates will be competitive. Many employers at one time or another throughout their corporate history will have to defend their enrollment and benefit processes in court.  Some common employee benefit issues could be; the enrollment form was completed and premiums were deducted from the employee’s paycheck but the form was inadvertently not sent to the insurance company.  Maybe proper COBRA notice was not provided to an employee that fell below the required hours of service in order to maintain the qualification for coverage and was terminated without any continuation options afforded to the employee (State or Federal). Research for this article reveals that there are 450 lawsuits, on average, filed each and every day related to various employee benefit administrative issues.  In an era of new legislation where the employee benefit environment is quite litigious, employers are looking for ways to ease their administrative burden while meeting the compliance standards of the old and new regulations. GBS has developed programs that specially address the administrative needs for employers.  Small to mid sized employers that do not have a dedicated Human Resource person, or the employer may have an HR person but that person may be overloaded with administrative responsibilities as a result of this stressed economy and find that these services take a huge workload off their staff and ensure compliance with employee benefit regulations.  Employers Present Situation:  * Major Medical Carrier – 1 Carrier form  * Life Carrier – 1 Carrier form  * Dental Carrier – 1 Carrier form  * Vision Carrier – 1 Carrier form  * Disability (STD & LTD) – 2 Carrier forms  Grand Total: 6 forms After the GBS Consolidation Program:  *Major Medical Carrier – 1 Carrier form  *Ancillary Coverage – 1 GBS form              - Life              - Dental              - Vision              - Disability Grand Total: 2 forms GBS can consolidate all lines of coverage into only 1 monthly billing and GBS can provide complete COBRA administration services. At GBS, we partner with employers to develop programs that meet their specific goals. We respectfully ask for an opportunity to provide you with a detailed proposal for a complete turn-key program that you will be proud of and that will meet the growing needs of your organization.urn:uuid:b6ce26b8-a448-49e2-a4e0-cd79724fd3cfEmployers jettison clunky old health plans!Employers jettison clunky old health plans! By: James M. Deren Healthcare reform is causing many employers to reconsider the type of healthcare program they offer to their employees. Many employers struggle to maintain the grandfathered status of ...Mon, 25 Jul 2011 13:50:44 -0500Employers jettison clunky old health plans! By: James M. Deren Healthcare reform is causing many employers to reconsider the type of healthcare program they offer to their employees. Many employers struggle to maintain the grandfathered status of their health plan in order to preserve some of the features the plan has to save premium dollars. Maintaining the grandfathered status is a pretty illusive prospect because virtually any changes made to a plan causes the program to lose its status. Conversely, many other employers feel that trying to maintain this status on their plan will end up costing them more money because of the administrative burdens, and in fact, some carriers charge higher premiums due to the increase of plan management just to maintain this status. Because of all the turmoil and changes created by so much legislation, employers are considering all types of healthcare plan options to provide benefits to their employees at the best possible price. One of the funding options that appear to be surfacing as the tool of choice for employers to save money is self-funding. According to a Deloitte Advanced Analytical Consulting Group, a recent Department of Labor (DOL) report indicated that fully insured premiums increased by $808 while self-funding only increased by $248, a difference of 326 percent (SIIA, 2010). Since fully insured health plans are rapidly increasing at a higher pace than self-funded plans, employers are embracing the idea of self-funding.  This funding method gives power back to the employer by providing greater plan control, and enhancing plan transparency, which appears to be yielding greater savings. In fact, transparency alone seems to create more reserves under these programs because employers see every penny spent in the plan. With greater control and increased transparency, employers are able to hold different companies more accountable (Pharmacy Benefit Managers, Preferred Provider Organizations, Brokers and Third Party Administration Firms) for the cost and quality of the services they provide to the plan and its members. Transparency is arguably one of the most compelling reasons many employers change to self-funding for their employee benefit plan.  Another huge reason employers are embracing this type of program is that employers book unused funds not spent on plan costs as reserves. Employers feel more in control of their healthcare future when they hold reserves instead of the insurance company. Self-funded health plans can further create additional reserves and savings from many of the same revenue streams as the fully insured programs. For example, a Pharmacy Benefit Manager is an organization that provides insurers and self-funded health plans prescription drug services. This sector of the health plan has long been a profit center for the fully insured carriers (referred to as box companies). Anytime a plan member fills a prescription, the insurance company or health plan receives a rebate. The rebates are much larger on a 30-day supply prescription at the pharmacy than the lower cost 90-day supply from mail order fills.   As a result of higher rebates on a 30-day supply prescription fills, many fully insured box companies are reluctant to incentivize plan members through plan design towards lower cost mail order fills. Under the self-funded health plans, the rebates remain with the plan to offset costs and go towards building sustainable reserves. Overall, employers are indirectly paying for the rebates that go to the insurance companies. The rebates paid to insurers provide absolutely no benefit to the employers’ health plan.  These transparency issues in the pharmacy program as mentioned above is only one of the many reasons employers of all sizes are converting to self-funding. Another issue that is becoming more dominant in the health insurance market, are carriers consolidating which erodes competition. A recent study by the American Medical Association (AMA) indicated that only one or two health insurers dominate many health insurance markets (for fully insured box companies) in the United States. The study revealed that in 48 percent of the metropolitan areas, at least one insurer had 50 percent or more of the market shares (American Medical Association, 2011). Further, there are far more reinsurance carriers that offer stop-loss coverage for self-funded health plans than fully insured in a given market. The increased number of stop-loss carriers provides much more competition for employers to assist them in keeping costs at bay. At GBS, we “partner” with employers to develop health plans that meet their specific goals. Any reserves created in the plan stays with the plan. We respectfully ask for an opportunity to provide you with a detailed proposal for a complete turn-key program that you will be proud of and will meet the growing needs of your organization.