IRS Private Letter Ruling Allows Employer to Increase Plan Design Flexibility

By Remy Samuels - The Internal Revenue Service recently approved a private letter ruling to an anonymous employer that allows its employees to elect where they would like that employer’s nonelective contributions to employee accounts to be allocated. Read Full Article… 

HVBA Article Summary

1. Innovative Employer Contributions: The ruling allows employees to choose how to allocate employer contributions among various options, including 401(k) plans, health savings accounts, and student loan repayments. This flexibility aims to address diverse employee financial needs and preferences.

2. Compliance and Administration Challenges: Implementing a choice program requires careful tracking of contributions to avoid tax implications and ensure compliance with IRS regulations. Employers must navigate complexities related to nondiscrimination testing, contribution limits, and coordination across multiple benefit vendors.

3. Potential for Broader Adoption: The approval serves as a precedent for other employers considering similar flexible plans. While interest is growing, potential adopters need to evaluate their specific employee demographics and plan provisions to design effective choice programs.

Association health plan bill is back, could reach House floor soon

By Allison Bell - Members of the House Education and the Workforce Committee voted 23-12 Sept. 11 to support a resolution promoting access to association health plans. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. AHP Program Expansion Background: The resolution seeks to overturn a Biden administration regulation that halted the expansion of Association Health Plans (AHPs), which originated from a 2018 Trump administration initiative. This initiative allowed small employers in metropolitan areas to collaborate and offer self-insured health plans under a broader definition of "employer."

2. Concerns Over Market Impact: Critics, including Rep. Robert Scott, argue that reinstating the old AHP definition could create a two-tiered health insurance market that disproportionately benefits younger, healthier individuals, while potentially raising premiums for others. The Biden administration's revised definition aims to prevent such market distortions.

3. Support for Telehealth Regulations: In addition to the AHP resolution, the House Education and the Workforce Committee passed the Transparent Telehealth Bills Act of 2024, which prohibits telehealth providers from imposing facility fees on employer-sponsored health plans. This bill, approved unanimously, aims to protect employers from excessive telehealth costs.

ERISA proponents roll out laundry list of desired improvements

By Noah Tong - More than 330 healthcare organizations signed letters this week urging the White House and Congress to extend a telehealth prescribing flexibility that was introduced during the Covid-19 pandemic. Read Full Article… 

HVBA Article Summary

1. Support for ERISA Preemption: Experts, including Elise Schuman from the American Benefits Council, emphasized the importance of ERISA preemption, which ensures uniform health benefits standards across states. They expressed concern that state-level regulations could complicate administration for self-funded group health plans, leading to disparate benefits for employees based on their location.

2. Calls for Expanded Protections and Price Transparency: Advocates like Anthony Wright from Families USA urged Congress to expand protections under the No Surprises Act to include individuals in self-insured plans and to enhance price transparency provisions, highlighting the stalled Lower Costs, More Transparency Act as a crucial legislative effort.

3. Discussion on Individual Coverage Health Reimbursement Arrangements (ICHRA): In a dialogue between Rep. Eric Burlison and Paul Fronstin, the potential of ICHRAs was explored as a means for employees to select insurance independent of employment. Despite their promise, less than a million individuals currently utilize ICHRAs, indicating a need for increased awareness and education on this option.

Elevance intensifies Ozempic crackdown

By Rylee Wilson - Anthem Blue Cross Blue Shield is requesting payments from some providers it alleges falsified patients' medical records when prescribing Ozempic, Bloomberg reported Sept. 12. Read Full Article…

HVBA Article Summary

1. Repayment Requests for Ozempic: Elevance Health, which owns Anthem BCBS, has contacted a limited number of providers requesting repayments exceeding $1 million for Ozempic prescriptions, primarily linked to concerns over off-label use.

2. Coverage and FDA Approval: Anthem BCBS only covers Ozempic for patients diagnosed with Type 2 diabetes, despite its common off-label use for weight loss, which is not FDA-approved. In contrast, Wegovy, containing the same active ingredient, is approved specifically for weight loss.

3. Concerns Over Healthcare Fraud: In correspondence with providers, Anthem highlighted that the off-label prescription of diabetes medications has surged and warned that falsifying medical records to obtain insurance coverage constitutes healthcare fraud. Providers maintain they prescribed Ozempic appropriately, despite Anthem’s concerns.

Why the largest PBMs may be focusing on specific markets: study

By Paige Minemyer - A new study suggests major pharmacy benefit managers may be focusing on specific payer segments in a bid to maintain strong market share. Read Full Article…

HVBA Article Summary

1. Market Share Dominance: CVS Health's Caremark leads the pharmacy benefit manager (PBM) market with a 31.3% share, significantly outpacing competitors like Cigna's Express Scripts (22.1%) and UnitedHealth Group's Optum Rx (20.2%). Notably, Caremark controls 39.2% of the Medicaid managed care market, raising concerns about network access for beneficiaries.

2. Impact on Access and Costs: Dima Qato, Ph.D., highlights that CVS's dominance could limit patient access to nearby pharmacies not designated as "preferred," potentially leading to increased costs and reduced medication adherence. This issue is particularly critical for Medicaid beneficiaries who may be unaware of the implications of preferred pharmacy designations.

3. Regulatory Scrutiny and Transparency: The concentration of PBMs has drawn attention from policymakers and regulators, with reports indicating that the four largest PBMs control over 70% of the market. The Federal Trade Commission has called for further scrutiny and regulation, emphasizing the need for transparency regarding PBM operations and their effects on medication access and health disparities.

A look at how Mass General Brigham recovered from the CrowdStrike outage

By Cassie McGrath - Just like any other Friday at 1:45am, Adam Landman was fast asleep on July 19. But unlike any other Friday morning, Mass General Brigham (MGB)’s chief information officer was woken up by a phone call about the last thing someone with his title wants to hear: a cyber outage. Read Full Article… 

HVBA Article Summary

1. Incident Overview and Response: Initially perceived as a malicious attack, the major cyber outage affecting MGB was traced back to a CrowdStrike failure linked to a Microsoft update. In response, MGB leadership activated downtime procedures, opening command centers and transitioning to manual documentation to manage patient care until systems were restored.

2. Challenges and Recovery Efforts: With over 45,000 computers affected, MGB faced significant challenges in recovery. The manual unlocking of security features like Microsoft BitLocker was time-consuming, leading to a breakthrough when the tech team developed a streamlined USB solution, enabling rapid recovery across the network.

3. Lessons Learned and Future Preparedness: The incident highlighted the increasing vulnerability of healthcare systems to digital threats, emphasizing the need for resilience and security in infrastructure. MGB's experience serves as a reminder that cyber incidents can arise unexpectedly, necessitating proactive measures and robust recovery plans.

AI Can Help Better Manage Polypharmacy Patients, Study Shows

By Katie Adams - New research was published this week analyzing how AI can be used to better manage medications for senior patients with polypharmacy — meaning they use multiple medications simultaneously to treat various conditions. Read Full Article…

HVBA Article Summary

1. Efficacy of FeelBetter’s AI Platform: A study from Brigham and Women’s Hospital found that FeelBetter’s AI platform accurately delivered medication warnings in 89.2% of cases, significantly aiding clinicians in optimizing medication therapy for patients at risk of deterioration.

2. Addressing Polypharmacy Risks: The platform targets the growing issue of polypharmacy among senior patients, which contributes to poor health outcomes and increased healthcare costs. By identifying patients at high risk for preventable hospitalization, it enables providers to allocate resources effectively and intervene proactively.

3. Integration with Healthcare Systems: Brigham and Women’s Hospital is working to fully integrate FeelBetter’s platform into its Epic EHR system, enhancing the capability of healthcare providers to monitor patient progress and adjust care plans based on real-time data insights.