President Trump Signs Executive Orders to Lower Prescription Drug Costs

Posted July 29, 2020 by Megan DiMartino

By: Keenan & Associates, an AssuredPartners Company

On July 24, 2020, President Donald Trump signed four executive orders that focused on lowering prescription drug prices. All of these executive orders direct the Secretary of Health and Human Services (HHS) to make determinations and promulgate rules that would put the executive orders into effect. Therefore, these executive orders have no current impact on prescription drug pricing, commercial self-funded employer pharmacy programs or fully-insured group health plans.

Prescription Drug Re-Importation

This executive order directs HHS to, “as appropriate and consistent with applicable law,” act to expand access to imported prescription drugs from Canada and other countries by taking the following steps:

  • Facilitating individual waivers already available under the Federal Food, Drug, and Cosmetic Act (FDCA), provided such importation poses no additional risk to public safety. The risk to public safety is a high hurdle, considering that is the very reason drug re-importation is generally not allowed.
  • Authorizing the re-importation of insulin upon a finding by HHS that it is required for emergency medical care.
  • Finalizing the proposed rule to allow importation of certain prescription drugs from Canada. This rule, promulgated by HHS in 2019 but never finalized, would allow states, wholesalers or pharmacists to develop and submit to HHS for review pilot programs to import certain drugs from Canada that are versions of FDA-approved drugs and manufactured consistent with FDA approval. Again, safety is a hurdle for this rule.

Drug manufacturers have consistently fought against drug re-importation. Moreover, the Canadian Government has also rejected importation proposals, saying importation would deplete the country’s own supply of prescription drugs.

Pricing of Insulin and Injectable Epinephrine Through the 340B Program

This executive order requires HHS to take action to ensure that future grants to Federally Qualified Health Centers (FQHCs) are conditioned on the FQHC’s having established practices to make insulin and injectable epinephrine available at the discounted price paid by the FQHC grantee or sub-grantee under the 340B Prescription Drug Program to individuals with low incomes who have a high cost-sharing requirement for those medicines, have a high unmet deductible, or have no health insurance. This executive order is quite limited in scope. An FQHC is a clinic that provides comprehensive primary and preventive care to patients in under-serviced and rural areas. There are only about 1,368 FQHCs receiving federal grants under Section 330 of the Public Health Service Act. The executive order would not impact hospitals or clinics that are not FQHCs.

Rebate Pass-Through to Medicare Part D Beneficiaries

If it goes into effect, this executive order will narrow the safe harbor for drug rebates under the federal anti-kickback statute, while still permitting plan sponsors, pharmacies and PBMs to apply discounts at the Medicare Part D beneficiary’s point-of-sale. Prior to taking this action, the executive order requires the Secretary of Health and Human Services to publicly confirm that the action is not projected to increase federal spending, Medicare beneficiary premiums, or patients’ total out-of-pocket costs. A Federal Government analysis of a similar proposal last year concluded that it could increase Medicare Part D premiums by 25-40% and that it would cost the Federal Government $177-$196 billion over ten years. In light of these costs, it is hard to see how HHS could confirm that the action will not increase federal spending or beneficiary premiums.

Index Pricing for Physician-Administered Drugs Under Medicare Part B

While the President announced this executive order, he has postponed moving ahead with it until August 24, 2020 to give pharmaceutical companies time to come up with an alternative pricing plan. It has not been published on the White House website, but as reported in the media, this plan had already been promulgated in proposed regulations in 2018, but never finalized. It would establish target prices for an as-yet undisclosed number of drugs under Medicare Part B. The target prices would be tied in part to an international pricing index (IPI), which includes the prices of the same physician-administered drugs in 15 other countries. If the plan moves forward, it is likely to be the subject of legal challenges as there is some question as to whether the Centers for Medicare and Medicaid Services (CMS) have the statutory authority to enforce such a rule.

Resources:


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

HRCI & SHRM Pre-Approved Webinar | 2020 Compliance Mid-Year Roundup

Posted July 14, 2020 by Megan DiMartino

Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as Patrick Haynes, AssuredPartners’ General Counsel and SVP of Compliance, covers the following compliance topics through 2020 thus far:

  • IRS Notices 2020-29, 2020-33
  • Changes to Cafeteria Plans, HCFSAs, HSAs, DCAPs, and more
  • COVID-19 Relief and Changes
  • Other DOL, IRS, and HHS Guidance, including our blog topics beginning from February 2020

Webinar Details:

  • Thursday, July 23, 2020
  • 2:00pm – 3:00 pm EDT

Register Now


*The use of this official seal confirms that this Activity has met HR Certification Institute’s® (HRCI®) criteria for recertification credit pre-approval.

*AssuredPartners is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

US Supreme Court Rules – Federal Law Protects LGBTQ at Work

Posted June 17, 2020 by Megan DiMartino

By: Cindy Wagner, AssuredPartners’ Director of HR Professional Services

On Monday, June 15, 2020, by a vote of 6-3, and for the third time since 2003, the Supreme Court ruled that existing Federal law forbids job discrimination on the basis of sexual orientation or transgender status. And, this time, by applying the workplace protections inscribed in the 1964 Civil Rights Act to gay and transgender employees. The ruling takes effect immediately. This action is a major victory for advocates of gay rights and for the emerging transgender rights movement.

Previously, the Supreme Court addressed this matter on October 8, 2019, at which time they were closely divided after hearing two (2) hours of courtroom arguments on the important issues of the term – whether existing Federal law forbids job discrimination on the basis of sexual orientation. The Court was to decide whether Title VII of the Civil Rights Act of 1964, which makes it illegal for employers to discriminate because of a person’s sex (among other protections – see below), also covers sexual orientation and transgender status. One case was presented on behalf of Gerald Bostock, who was fired from a county job in the state of Georgia after he joined a gay softball team. An attorney argued the employer discriminated against the man because it treated him worse than women who were doing the same work and the discrimination was because of sex. It was further explained that when an employer fires a male employee for dating men, but does not fire a female employee who dates men, the employer violates Title VII of the Civil Rights Act.

Per Title VII of the Civil Rights Act of 1964, it is unlawful for an employer to discriminate against employees and job applicants on the basis of race, sex, color, religion or national origin. Specifically, all companies with fifteen (15) or more employees are required to adhere to the rules set forth by Title VII of the Civil Rights Act. An employer violates Title VII when it intentionally fires (or refuses to hire) an individual based in part on sex. It is irrelevant if other factors, aside from the individual’s sex, contribute to the employer’s decision. This is because it is a Title VII violation if an employer intentionally relies in part on an individual’s sex when taking negative employment action against them.

In Bostock, the Georgia case, the court held that because discrimination on the basis of homosexuality or transgender status requires an employer to intentionally treat individuals differently because of their sex, an employer who intentionally penalizes an individual for being homosexual or transgender also violates Title VII.

The Supreme Court said Title VII of the Civil Rights Act of 1964 also covers sexual orientation and transgender status. They upheld rulings from lower courts that said sexual orientation discrimination was a form of sex discrimination.

The Supreme Court also provided firm clarification and guidance regarding the following:

  • It’s considered irrelevant what an employer might call its discriminatory practice, how others might label it, or what else might motivate it. When an employer fires an employee for being homosexual or transgendered, it intentionally discriminates against that individual in part because of sex.
  • An individual’s sex does not need to be the sole or primary cause of the employer’s adverse action. It’s of no significance if another factor, such as an individual’s attraction to the same sex or presentation as a different sex from the one assigned at birth, might also be at work, or even play a more important role in the employer’s decision.
  • Employers cannot escape liability by demonstrating how it treats males and females comparably as a group. An employer who intentionally fires a homosexual or transgender employee in part because of their sex violates the law even if the employer is willing to subject all male and female homosexual or transgender employees to the same rule.

Across the United States, we now have twenty-two (22) states that have passed their own laws which prohibit job discrimination based on sexual orientation or gender identity. In addition, there are seven (7) states that provide protection only to public employees. Those laws will continue to remain in force. However, with Monday’s ruling, Federal law now provides similar protections for LGBTQ employees throughout the rest of the United States.

Gay rights advocates celebrated the ruling as gay and transgender rights groups considered the case and outcome a major victory. Many describe this ruling as more important than the fight for the right to marry, as nearly all LGBTQ adults have or need employment. The groups also acknowledged that sexual orientation was not on the minds of anyone in Congress when the Civil Rights Law was first passed.

Also, on June 15, 2020, the Society for Human Resource Management (SHRM) issued the following statement: “SHRM applauds the U.S. Supreme Court today for its ruling making clear employment discrimination on the basis of an employee’s sexual orientation or gender identity is illegal. The ruling provides much needed clarity and finality on the interpretation of Title VII’s protections from the Court giving HR professionals clear guidance and a greater opportunity to create a world of work that works for all.”

So, you may be asking – how does this impact my company or my employer?

Human Resources Compliance is now more important than ever!

It’s time to:

  • Review and update your employee handbooks
  • Review and update your policies and procedures (e.g., hiring and termination)
  • Update your employment law posters
  • Train your HR professionals, managers and employees in all aspects of HR compliance, sensitivity, civility in the workplace, and diversity and inclusion

And when in doubt, contact your AssuredPartners Human Resources Consultant and/or legal advisor.

Resources:


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

PCORI Fee Increased for Plan Years Ending After October 31, 2019

Posted June 8, 2020 by Patrick Haynes

Today, the IRS Released the new Patient-Centered Outcomes Research Institute (PCORI)/Comparative Effectiveness Research Fee (CERF) rate for plans ending after October 31, 2019.  That new rate is $2.54 per person.  IRS Notice 2020-44 can be viewed here.

You may recall that PCORI was previously due to sunset in 2019, but was extended by Congress through 2029 (see prior guidance/updates here).

And, if you are looking for details on how to calculate PCORI, please read our prior guidance here or contact your Account Manager.

Links:


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

HRCI & SHRM Pre-Approved Webinar | In Times of Challenge, Embrace the Change: Drive Lower Costs & Better Outcomes in Your Health Plans

Posted June 4, 2020 by Megan DiMartino

Sick of hearing about COVID-19? We all are. Yet, one “silver lining” to these difficult times is that adversity often illuminates new ways of doing things and new methods for greater efficiency. Some of those changes you can embrace are ones that can drive lower costs and better outcomes in your health plan.

Join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as Scott Mayer, AssuredPartners’ Director of Data Analytics, outlines strategies (some old, some new) that employers are exploring to improve cash flow, enhance benefits, lower claims/premiums and drive more favorable outcomes.

Webinar Details:

  • Tuesday, June 16, 2020
  • 2:00pm – 3:00 pm EDT

Register Now


*The use of this official seal confirms that this Activity has met HR Certification Institute’s® (HRCI®)  criteria for recertification credit pre-approval.

**AssuredPartners is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC.


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

IRS Releases 2021 Limits for HSAs

Posted May 21, 2020 by Patrick Haynes

On May 20, 2020, the IRS released Revenue Procedure 2020-32.  It provides the 2021 inflation-adjusted amounts for HSA-qualified high deductible health plans (HDHPs).

The inflation-adjusted increases for 2021 are:

  • HSA-Qualified HDHP Self Coverage: Annual deductible must be $1,400 or more in 2021 (up $50 from 2020), and annual out-of-pocket expenses cannot exceed $7,000 (up $100 from 2020).
  • HSA Contribution Limit for Self Coverage: Increases to $3,600 in 2021, up $50 from 2020.
  • HSA-Qualified HDHP Family Coverage: Annual deductible must be $2,800 or more in 2021 (no change from 2020), and annual out-of-pocket expenses cannot exceed $14,000 (up $200 from 2020).
  • HSA Contribution Limit for Family Coverage: Increases to $7,200 in 2021, up $100 from 2020.
  • No change to the Age-55+ HSA catch-up limit.  That value remains at $1,000 per year.

Please contact your Sales Executive or Account Manager for additional details about how this may affect your 2021 HDHP-HSA offerings.    And, don’t forget to review our 2021 non-HDHP plan limits here.

Links:


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

HHS Provides 2021 Benefit Payment Out-of-Pocket Limits

Posted May 19, 2020 by Patrick Haynes

Earlier this week, the Department of Health and Human Services (HHS) published finalized 2021 Benefit Payment Parameters with an $8,550 out-of-pocket maximum for self-only coverage and $17,100 for family coverage for health plans beginning in 2021. See, the 5/14/2020 Federal Register publication here.

Under the Affordable Care Act (ACA), non-grandfathered health plans are required to comply with an overall annual limit on out-of-pocket expenses for essential health benefits. The current limits, for 2020 plan years, is $8,150 for self-only coverage and $16,300 for family coverage.

The IRS has also released information on what the 2021 requirements will be for high-deductible health plans (HDHPs) and health savings accounts (HSAs). The HDHP/HSA requirements include a minimum deductible, a maximum out-of-pocket limit and a maximum HSA contribution amount. These requirements apply to both grandfathered and non-grandfathered group health plans.

Here’s a summary of both traditional plans and HDHP/HSA plans for the 2020/2021 plan years:

If your plans offer both traditional and HDHP/HSA plans (that are not grandfathered), your plans are subject to both sets of requirements and you must ensure compliance with the lowest applicable out-of-pocket maximum.  Plus, the ACA requires that a per person (individualized/imbedded) out-of-pocket maximum doesn’t exceed the ACA limit, even if you are in the larger (family) tier.

The rule also finalizes the treatment of drug manufacturer support, including coupons, as it relates to the participant’s maximum out-of-pocket exposure. We previously shared guidance (Sept. 4, 2019) about this.  Health plans have the ability/the option to determine whether they will count the value of a drug manufacturer’s coupons/other assistance when determining if a participant has satisfied his or her cost-sharing obligations (provided that this is consistent with state law).

Links:

Prior guidance:


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

AssuredPartners Town Hall Webinar | Insurance Expense Reduction and Cost Control Solutions

Posted May 14, 2020 by Megan DiMartino

AssuredPartners is pleased to continue our Town Hall meeting series this week with a focus on Insurance Expense Reduction and Cost Control Solutions. Based on feedback surrounding the topic this week, we will cover the following topics for discussion with our presenters:

  • Cost Control Solutions for your Business
  • Insurance Expense Reduction Options
  • COVID-19 and Workers Compensation Insurance
  • Increased Business Liability and Employment Matters

Please join us for a one-hour, town-hall style meeting.

Webinar details:

  • Friday, May 15, 2020
  • 2:00pm – 3:00 pm EDT

Submit a Question & Register


For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

AssuredPartners Webinar | Emergency FMLA: What is it and What Now? HRCI & SHRM Pre-Approved

Posted May 12, 2020 by Megan DiMartino

COVID-19 legislation is changing the landscape of regulatory compliance for the remainder of 2020. Please join us for this HRCI* and SHRM** pre-approved, complimentary, one-hour webinar as ERISA Consultant, Olivia Ash, JD, reviews details of federal emergency FMLA legislation and covers essential benefit plan considerations impacted by COVID-19.

Webinar Details:

  • Thursday, May 21, 2020
  • 2:00pm – 3:00 pm EDT

Register Now

Presenter Bio:
Olivia Ash, JD, MS, brings fifteen years of management experience to regulatory compliance education. After receiving her BS in Exercise Science and an MS in Physical Education from Indiana University, Olivia spent a decade advising employers on wellness program implementation. She completed her JD at Indiana University’s McKinney School of Law. Presently, Olivia is a Compliance Consultant with ComplianceDashboard, LLC, focusing on ERISA’s application to health plans. She creates and presents live webinars, writes content, conducts national continuing education courses, and speaks at various conferences. Olivia is an experienced educator; she holds an Indiana state teaching license and currently serves as Adjunct Faculty at the Indiana University School of Health and Human Sciences. To maintain wellness, Olivia paints abstract art and enjoys road cycling.


*The use of the HRCI seal confirms that this activity has met HR Certification Institute’s criteria for recertification credit pre-approval.

**AssuredPartners is recognized by SHRM to offer Professional Development Credits (PDCs) for SHRM-CP or SHRM-SCP. This program is valid for 1 PDC.


 For more information, contact info@apbenefitadvisors.com. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.

AP Benefit Advisors’ webinar and website resources are designed for U.S.-based organizations. Our privacy and GDPR policy should be reviewed here. Please opt-out if you do not agree to these terms and conditions.

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