Is a Pharmacy Carve-out Right for Your Group Health Plan?

Pharmacy spend in the US is significant. Six in ten adults tell KFF.org they are currently taking at least one prescription drug and a quarter say they currently take four or more prescription medications.

PwC’s Behind the Numbers predicts a 6.5% medical cost trend in 2022, while drug cost trend reports show ongoing increases year over year and make up 20% of overall medical costs for employers.

Besides the cost burden on employers, employees can find that certain medications are not covered by their health plan. This increases pressure on employers to develop a sustainable strategy that provides cost-effective pharmacy benefits.

As a solution, many employers consider pharmacy carve-out plans as an option; however, carve-out plans are debated vigorously by health plan experts. By understanding what a pharmacy carve-out is and considering important factors, employers and brokers can work together to make the right decision.

What is a pharmacy carve-out?

A pharmacy carve-out is when an employer separates (carves out) their prescription drug benefits from their medical plan and contracts directly with a pharmacy benefit manager (PBM). A pharmacy carve-out is commonly used under the self-insured model. In comparison, fully insured medical plans typically have the pharmacy benefit as a built-in feature (bundle).

Advantages

Pharmacy carve-outs can provide transparency, flexibility, control, and accessibility to employers in the form of:

  • Better control over pharmacy benefit costs.
  • Access to the costs and data to evaluate program performance.
  • Greater flexibility to customize solutions in plan design and clinical programs to help reduce costs.
  • Standardized language in the PBM contract to allow increased transparency into pharmacy benefits, allowing employers to better understand and control spending, negotiate better deals, and ensure the program performs as promised. The contract itself can allow:
    • Access to pharmacy claims data.
    • Audit rights, such as a claims audit, operational assessment, and rebate audit.
    • Annual review to ensure rates are competitive.
    • Service performance guarantees.
    • Credits to help cover administration expenses or costs incurred when switching to a new vendor.

Disadvantages

There are a lot of variables that affect whether a pharmacy carve-out is the right solution for your company. It’s critical to understand the disadvantages of carve-outs before making your next move:

  • Carved-out plans offer short-term savings, though the savings might not be beneficial to an employer over the long term.
    • A July 2021 study compared the costs of bundled and carve-out plans and found that bundled pharmacy benefits are associated with reduced medical expenditures over the long term, resulting in annual per-member, per-month savings compared with a carve-out.
    • Another study found that savings from a carve-out plan may seem beneficial on the surface, but medical costs are 7.5 times higher in the long run. Therefore, any savings promised by a carve-out should be weighed against potential increases in medical spending by employers.
    • Managed Healthcare Executive also reported carve-outs could deliver short-term savings, but not long-term savings, due to PBM vendors’ approach to utilization management. For example, many employees are denied access to their prescribed medications and are unlikely to have their denial overturned on appeal. This results in employees paying for medicine out-of-pocket, added costs for employers if they pay multiple vendors, and a poor member experience overall.

Besides long-term costs, carve-out contracts for medical and pharmacy require multiple vendors, increasing the administrative burden on the employer.

Thoughtful considerations

After reflecting on the advantages and disadvantages of carve-outs, making the decision may still be no small feat. Fortunately, you can ask yourself important questions to help you with your decision.

  1. How much are pharmacy benefits currently costing your plan?
  2. How are you currently overseeing the pharmacy benefits program?
  3. What changes would be necessary for the new arrangement?
  4. How will the fees from your medical health plan vendor be impacted?
  5. Is now the right time to search for a PBM vendor (and possibly a medical health plan request for approval)?

When deciding to carve-out pharmacy benefit programs, employers and brokers should work together to consider critical factors such as internal staff expertise, current and future costs, and appropriate timing. However, your top consideration should be, “Does this make the most sense for our organization and our employees?”

 

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Protect Your Small Business from Cybersecurity Threats

Is your business doing enough to protect itself from cyberattacks?

Cyber-attacks on small to medium-sized businesses (SMBs) have seen a sharp rise in the last few years. A 2019 report by the Ponemon Institute found that cyberattacks increased by over 20% between 2016 and 2019.

Data breaches cost not only time but also money. The FBI’s Internet 2020 Internet Crime Report found that the total cost of cybercrimes in the US in 2020 reached 2.7 billion, and with an average cost of a data breach for an SBM being $149,000 (2019), small business leaders must take the necessary steps to improve their risk mitigation for cyberattacks.

The first step is to familiarize yourself with the many different types of cyber threats that exist.

What are the most common forms of cyber-attacks on SBMs?

  • Phishing: Phishing attacks come in the form of communications disguised as coming from a reliable source. They can be emails that look like correspondence from company leaders or departments like the CEO, CFO, or Payroll. They can also be made to look like they come from a legitimate organization and prompt you to download a file, open a link, or provide sensitive information which will allow attackers access to your device.
  • Man-in-the-middle (MitM): MitM attackers intercept a two-party transaction. This usually happens when someone uses their device on an unsecured network such as public Wi-Fi. Attackers intercept the connection and steal information from the vulnerable computer, such as credit card numbers, bank account information, or passwords.
  • Malware: Malware is an umbrella term for many different attacks such as viruses, trojans, and spyware. Malware can be downloaded on a device by clicking a link that will install software onto the device. This “software” is designed to steal information or data, control the device, or otherwise impede the device’s functioning. Here are a few common types of malware:
    • Ransomware will gain access to sensitive files or data and deny the victim access unless a ransom is paid, often threatening to expose it, sell it, or delete it entirely.
    • Trojans are an attack using software that plants itself within an app or a program—often used to give attackers access to the device.
    • Spyware is software designed to track users on their devices and send the sensitive information it collects to a third-party attacker.
  • Denial of service: Denial of Service (DoS) cyberattacks target and overload a server’s capacity and bandwidth, resulting in a server crash that takes it offline from actual customers who want to visit the website or purchase something from it. This is done by overloading the server with requests so it can’t process legitimate requests.

How can you protect your business?

There are multiple cybersecurity platforms available for businesses that are easily found with a quick Google search. There are also many options for free cybersecurity software that can be upgraded with subscription services. Aside from implementing company-wide cybersecurity software on all company-linked devices, there are some standard practices that any business should be using, whether or not they have access to protective software.

1. Create a password policy

According to the
Ponemon report, 54% of SMBs have no insight into their employees’ password practices. Terrible password habits equate to seriously increased vulnerability to cyberattacks. Consider implementing
1Password or other password protection software programs that can be downloaded on every computer associated with your organization.

Ensure your employees aren’t saving their passwords in easily accessed folders. Have employees use password-generating programs to increase their passwords’ strength and ensure they don’t use the same password twice. A common way for cyberattacks to find saved passwords on devices is to do a device-wide search for words that are 8, 12, 16, and 24 characters long, meaning that even if employees save their passwords in a nondescript file, it’s easy enough to identify them. This is where secure folders and password protection programs come in handy.

2. Create a software update policy

Another common issue that causes device vulnerability is outdated software. Create a policy that requires employees to update their software as soon as a new update is released. Software updates are often released to fix security issues and vulnerabilities, so it’s critical employees don’t wait to update their devices.

3. Education and training

Finally, organizations must educate and train their employees to identify and protect themselves from potential cyberattacks. Start with including a training session during onboarding to ensure employees start with good practices from the beginning. Hold company-wide training sessions, and ensure you revisit the topic throughout the year.

 

Take a proactive approach

You may not be able to stop cyberattacks from targeting your business, but there’s a lot you can do to thwart them. By taking a proactive approach, educating your employees, and developing up-to-date risk management policies, you can save your business from dealing with damaging costs, harm to your reputation, and potential lawsuits. Take action early, and rest easy knowing you are protected.

 

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Pet Insurance – A Pet Owner's Best Friend

Animal healthcare costs are rising, with $31.4 billion spent on veterinary visits and care in 2020. Because of this, pet owners tend to go into credit card debt and miss a payment on bills to pay for their pet’s care. In fact, a survey of 1,000 pet owners found that 45% of pet owners spend the same amount, or more, on their pet’s healthcare than they do on their own. 

If your employees have pets, chances are they consider them to be well-loved and beloved family members. Pet insurance may be a benefit you want to offer to your employees.

What is pet insurance, and what does it cover?

Pet insurance pays—in part or total—for veterinary treatment of a person’s ill or injured pet. It covers things like:

  • General wellness exams
  • Booster shots and vaccinations
  • Flea prevention
  • Medical costs for emergency care
  • Chronic conditions (e.g., arthritis)
  • Acute illnesses (e.g., allergic reactions)
  • Acute injuries (e.g., a bone fracture)

What is the main benefit of pet insurance?

Having pet insurance ensures that cost will be less of a factor when it comes to providing pets the best possible care. With the average veterinary visit being between $50 to $400 on average, and the average emergency vet visit costing between $800 to $1500, employees will not have to choose between paying a bill or going into debt to give their pet the care they need.

What are the other benefits of pet insurance?

1. Delivers peace of mind

Not having pet insurance can make employees who own pets more stressed if they don’t know how to pay for their pet’s care, either preventatively or during an emergency. By offering this benefit, employees may be less stressed by this financial burden—and when employees are less stressed, they are more healthy, focused, and productive. Also, research shows owning a pet helps soothe anxiety and reduce blood pressure.

2.  Encourages employees to own pets

Pets are a significant emotional investment and a significant financial investment as well—pets require not only health care but also:

  • Food and treats
  • Dishes for their meals
  • Collars and leashes (for dogs and/or cats)
  • Grooming and nail trimming
  • Over the counter medications
  • Items for mental stimulation (e.g., toys)

For your employees who don’t have a pet but are considering purchasing or adopting one, a pet insurance benefit makes the choice of buying or adopting a pet easier since employees know their pets’ health needs will be a bit easier to manage.

3. Demonstrates to employees that you care

There are pet-friendly hotels, apartments, and restaurants, and by offering pet insurance, you send the message to your employees that your workplace, in this regard, is pet-friendly. You also demonstrate and support the idea that pets are important family members and deserve to be loved and taken care of. That is a genuine, loving, and caring message, which can also positively impact hiring and retention.

Pet insurance—protection for a pet’s wellbeing

By offering pet insurance, you will create a positive relationship with your employees, and they, in turn, will know that their pets can get the best care possible. If you are interested in providing this supplemental benefit to your employees and want to learn more about how it works, talk to a trusted consultant or advisor.

 

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Disability Insurance: Just the Facts

Insurance protects your employees and their families against any unexpected financial losses. Health insurance protects against unexpected health expenses, and life insurance gives your employees’ families financial security after an unexpected passing. But what about disability insurance? What is it, and why is it important to offer to your employees?

Here’s what you need to know about it.

What is disability insurance?

Disability insurance, also known as disability income insurance or income protection insurance, is a type of coverage that replaces a portion of your employees’ income if an injury or illness prevents them from working. Disability insurance:

  • Provides financial security for your employees and their loved ones
  • Gives funds to your employees to use for whatever they like

Is it the same thing as health insurance?

Not exactly. Disability insurance replaces a portion of an employee’s income lost due to not being able to work because of injuries or illnesses. In contrast, health insurance covers medical expenses that arise due to an injury or illness.

What does disability insurance cover?  

While people may think of major injuries as the only thing disability insurance covers, here are just a few of the things disability insurance might cover:

  • Arthritis
  • Back pain
  • Cancer
  • Depression
  • Diabetes
  • Heart disease

It doesn’t mean injuries like sprains and fractures aren’t disabling. What it does mean is the scope of injuries that can prevent people from earning an income is broad.

Why is disability insurance important?

A massive 68% of non-government workers carry no form of disability insurance. With this in mind, here is why disability insurance is essential to offer—and necessary for employees to have.

  • Injuries are all too common: The chance of missing months or years of work seems remote. But more than one in four 20-year-olds will experience a disability for 90 days or more before they reach 67, according to the Social Security Administration. Disability insurance covers those “what-if” or worst-case scenarios. 
  • Disability insurance covers risk: People tend to shrug off the risk because they think only about worst-case scenarios. But the leading causes of disability claims are:
     
    • Pregnancy
    • Cancer
    • Mental health issues
    • Musculoskeletal disorders affecting knees, back, and hips
    • Digestive disorders such as hernias and gastritis
    • Injuries including fractures, sprains, and muscle/ligament strains

Disability insurance covers the risk involved with being affected by injuries, situations, or illnesses.

  • It prepares employees for long-term challenges: It’s common to plan ahead and think about how far you can go without one or two paychecks. However, not enough people plan for possible long-term or future challenges. A study of consumer bankruptcy filings found that the primary reasons for bankruptcy involved illness or injury of themselves or a family member.

Also, workers’ compensation and Social Security do not cover most financial challenges:

Disability insurance gives employees an extra layer of protection to help prepare them and their families for any long-term challenges.

Consider offering disability insurance benefits

Absence of emergency savings and rising medical costs are a concern for many employees. Without added income protection, people may experience severe financial difficulty if they miss work due to injury or illness. Consider adding disability insurance benefits to your employee benefits package and be sure to talk to a trusted advisor to learn more.

 

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Three Financially Focused Benefits Your Employees Will Love

In the last two years, employees across the country have had to adapt and adjust to a lot of challenges, many of which organizations had little to no control over. Employee burnout, stress, and wellbeing took major hits, putting more pressure on organizations to come up with solutions to help them face these challenges. According to the 2021 Employee Benefit Trends Study by Met Life, 86% of employees said finances are a top contributing factor to their stress now and into the future. While this may feel like an insurmountable problem for employers to take on, there are many solutions that can make a big impact for both the wellness of your employees and the health of your business.

1. Student Loan Repayment Programs

Today, 47 million Americans are carrying the burden of student loan debt. This year, student loan debt in America reached a staggering 1.7 trillion dollars. Despite the temporary loan forbearance the Biden Administration placed on federal student loan payments, student loan debt remains a top concern for many Americans in the workforce.

Employers looking for ways to help support employees who are paying off student loans should consider offering employee benefits aimed at just that—helping them pay off this debt. In December, Congress passed the Consolidated Appropriations Act of 2021, enabling employers to contribute up to $5,250 in student loan payments tax-free, making it easier than ever for organizations to help.

Supporting employees burdened with student loan debt can be a strong tool for attracting and retaining top talent.

2. Retirement Planning

A 2019 study by GOBankingRates found that 64% of respondents expected to retire with less than $10,000 in their retirement savings. Employers can help employees prepare for retirement and reduce stress by offering benefits designed to enable employees to begin saving for retirement. Some plan options that provide tax benefits to both employers and employees include:

  • Payroll Deductible IRA – For employers who don’t want to implement a retirement savings plan, this plan offers a way for eligible employees to contribute to an IRA through payroll deductions.
  • 401(k) Plan – This plan offers an opportunity to employees to save through salary deferrals with the option of employer contribution.
  • Money Purchase Plan – This plan allows employers to make contributions to employee savings based on their discretion. There is no fixed amount nor requirement to make a contribution by the employer.

There are many types of retirement plans available to organizations, so do your research and choose the one that fits the needs of your business.

3. Education and stewardship

Understanding the basics of investing, saving, and money management is a challenge for many Americans, leading them to avoid this type of planning altogether. If your organization can’t offer benefits to help them save, consider offering a program to empower them through education.

Platforms like Skillshare and financialgym offer online courses to help anyone learn the basics of investing, planning for retirement and savings, and managing money. Knowledge and understanding can make a more powerful impact, in many ways, than simply offering a plan that no one understands.

Their financial wellness is your reward

Helping employees plan for retirement and effectively manage their savings and debt is a sure-fire way to improve their overall wellbeing by reducing stress and creating stability within their lives and futures. You may see an increase in talent attraction, employee engagement, retention, and satisfaction by offering a hand and enabling employees to create financial stability within their lives. What’s good for them is good for business.

 

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