New Law Bars Pharmacy Benefit Manager Gag Clauses

| posted in Blog, Newsletter

President Trump has signed two bills into law that would add transparency to drug pricing by banning gag clauses imposed by Pharmacy Benefit Managers (PBMs) that bar pharmacists from discussing drug prices with the person buying prescription medication. The bills, passed with bipartisan support, take aim at the PBM practice of clawbacks, which occur when the copayment set by the PBM is more than the actual cash price of the drug. So instead of the policyholder being able to pay less for the drug, the PBM will usually pocket the difference. And because of gag clauses, most policyholders never get…
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Drug Costs Starting to Drive Group Plan Inflation

| posted in Blog, Newsletter

Under the Affordable Care Act, group health insurance costs have been rising at a much slower rate than they had during the decade preceding its passage. In fact, the rate of annual premium growth in the group market has hovered around 5% – more than half of what it was between 2001 and 2010. Also, health care’s share of the national economy actually fell from 17.4% in 2010 to 17.2% by 2013. However, that trend hasn’t lasted and in 2016 the share was 17.9%. There has been a lot of debate about why rates have been increasing and some pundits…
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EEOC Eyes Employer Actions against Prescription Drug Users

| posted in Blog

By now you will be aware of the scourge of opioid abuse that’s swept the country over the past decade and the damage it is doing to individuals and families. Overdoses from legal prescription drugs – mostly opioids and other strong pain relievers – last year surpassed overdoses from street drugs like heroin for the first time. However, some employers are going too far in trying to prevent employees from taking certain medications while on the job and have as a result run afoul of the Equal Employment Opportunity Commission. As you would enter an interactive process when trying to…
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