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November 30, 2017 logo logo
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The Specialty Drug Challenge: An Executive Overview (PDF)
"While there is no silver bullet to manage specialty drug spend, plan sponsors that adopt a multifaceted approach can mitigate the expected cost increases.... [1] Contracts can incorporate favorable terms ... [2] Stringent requirements can be Imposed by formularies ... [3] Care management teams can add value to specialty Rx exclusive networks ... [4] Manufacturer coupons and incentives can reduce costs ... [5] Site-of-care alignment can reduce costs significantly ... [6] 340B strategy can yield shared savings."
Strategic Benefit Advisors


Join EBRI's December 14 Policy Forum!

Sponsored by Employee Benefit Research Institute [EBRI]

Learn about recent EBRI research and hear perspectives on the latest retirement, health, and financial wellbeing research and policy developments from expert panelists. Learn more and register here (attendance is free of charge).

Follow the Dollar: Understanding How the Pharmaceutical Distribution and Payment System Shapes the Prices of Brand Medicines
"Drug pricing is a complex and often confusing issue, shaped by a pharmaceutical distribution and payment system that involves multiple transactions among numerous stakeholders. A better understanding of the players involved in the pharmaceutical supply chain, and the role each plays in determining what patients ultimately pay for their prescription medicines, can help consumers and policymakers find answers to their questions and concerns about cost and access to medicines."
Pharmaceutical Research and Manufacturers of America [PhRMA]

Massachusetts Bill Aims to Curb Health Care Costs by Regulating Hospital Reimbursement Rates
"One of the primary ways the bill proposes to moderate costs is by establishing a hospital alignment and review council which will set a 'target hospital rate distribution,' the minimum floor payment that an insurance carrier must reimburse a hospital for services."
Foley & Lardner LLP

Finding the Right Path to Improved Healthcare Cost Control (PDF)
"Finding the right path to improved healthcare cost control and better employee attraction and retention isn't easy. Only the best of best succeed at both. See which tactics top large employers are using to outperform their peers." [Also online: an infographic pertaining to mid-sized employers.]
Arthur J. Gallagher & Co.

Addiction and Mental Health vs. Physical Health: Analyzing Disparities in Network Use and Provider Reimbursement Rates (PDF)
48 pages. "As state and federal regulators increase their focus on enforcement of mental health and addiction parity laws, nonquantitative treatment limitations have emerged as a key trouble area for some health plans.... Based on an analysis of two large research databases of administrative claims data, [the authors] have identified significantly higher rates of out-of-network use for behavioral care compared to medical/surgical care, and have also found that medical/surgical providers are paid at higher rates than behavioral providers, often for providing the same services."

HDHP Enrollment Increases Wellness Program Participation
"HDHPs encourage people to become more aware of their healthcare costs; with more financial awareness, people start looking for ways to reduce their expenses. Wellness programs offer a very effective tool for lowering costs."

Highest Rate of Employers Offering Health Care Benefits Since 2013, Despite Concerns About Looming Changes
"Nearly two in three employers (66 percent) say their company is extremely/very aware of the potential changes to health care policy coming out of Washington D.C.... 91 percent of employers think their employees are satisfied with the health insurance plans they offer, a finding consistent since 2014. Meanwhile, three in four employees are satisfied with the health insurance plan (77 percent) and other benefits (77 percent) their company offers to them."
Wolters Kluwer Law & Business

Paid Family Leave Arrives Soon to New York
"The New York Paid Family Leave Benefits Law (PFL) will initially require employers to provide eligible employees with eight weeks of paid leave at 50 percent of their salary.... The PFL applies to all private-sector employers regardless of size.... [F]amily leave is a benefit for people who work in New York; it does not matter where the employer is headquartered or where the employee lives. For example, an employee who works from home in New York is covered even if the employer is located outside New York."
Society for Human Resource Management [SHRM]

The Bipartisan Health Care Stabilization Act of 2017 and the Individual Mandate
"If legislation were enacted that incorporated both the provisions of the Bipartisan Health Care Stabilization Act and a repeal of the individual mandate, the agencies expect that the interactions among the provisions would be small; the effects on premiums and the number of people with health insurance coverage would be similar to those [published in October 2017]."
Congressional Budget Office [CBO]

The Health Coverage Stakes in the Tax Debate: The Individual Market and Beyond
"It is being reported that Maine senator Susan Collins (R) ... is considering supporting a Republican tax bill containing a repeal of the ACA's individual responsibility penalty in return for congressional enactment of two health care bills and other concessions.... The assumption underlying this trade-off is presumably that adoption of Alexander-Murray and Collins-Nelson would offset the damage done to the individual market by repeal of the individual mandate."
Timothy Jost, in Health Affairs

Benefits in General

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Executive Compensation
and Nonqualified Plans

Senate Finance Committee Speaks: Proposed Executive Compensation Changes
"[F]or 2018, an executive who is eligible for a governmental employer's 457(b) and 403(b) plans could contribute a maximum of $18,500 to both such plans ... instead of contributing $18,500 ... to the governmental 457(b) plan and $18,500 ... to the 403(b) plan. This proposed change would not apply to non-governmental 457(b) plans.... The tax-exempt employer executive compensation excise tax provisions are substantially similar in the Senate Finance Committee Bill and the House Bill. However, the Senate Finance Committee Bill clarifies that 'compensation' includes amounts required to be included in gross income under Section 457(f) of the Code."
Drinker Biddle

Recent Developments Affecting Performance-Based Equity Awards
"[1] [T]he most common metrics of performance awards at the 'Equilar 500' companies in 2016 were relative TSR (52.4%), ROC/ROIC (34.9%), EPS (30%), revenue (17.8%), and cash flow (14%).... [2] In September, RSUs granted by Apple in 2014 paid out at the end of their cycle after the associated performance conditions were met.... The footnotes in the related Form 4 filings ... provide details on the grant, including its payout scale, and an example of Section 16 reporting ... [3] [A] federal district court in Massachusetts ruled that a covenant of good faith and fair dealing applies to potentially protect someone with unvested performance-based grants."

Press Releases

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2017, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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