Weber Gallagher’s Post

You won’t want to miss out on this webinar where my partner David Greene and I will help guide you on managing and battling against medical exposure on your PA WC claims #risk #riskmanagement #workerscomp #claims #RIMS #insurance

Join us for an insightful webinar where we delve into the latest developments in Pennsylvania Workers' Compensation law and discover how recent caselaw can be a powerful tool for employers and insurers to save money. This session is led by partners David Greene and Ross Goren. During this webinar, our attorneys will cover: How to deny payment for prescription drugs when a prescribing doctor has a financial interest in a pharmacy. How to negotiate substantial cost savings on prescription medication given uncertainty about the appropriate AWP (average wholesale price). We will provide risk management strategies on how to stay compliant with the law while reducing soaring medical costs. Don't miss this opportunity to join our webinar, register now: https://lnkd.in/ep3tsNyZ #WorkersComp #PAWorkersComp

ERISA attorney Brandon Long takes the podium at the State Chamber of Oklahoma’s “Employers in Action” Lunch Series on Thursday, October 26, in Oklahoma City to discuss the use of pharmacy benefit managers to help manage health plan prescription drug costs, and to break down a federal court’s recent ruling in lawsuit challenging Oklahoma’s Patients’ Right to Pharmacy Choice Act. #statechamber #oklahoma #lunchseries #employers #series #drugcosts #healthplan #pharmacybenefitmanager #pharmacy #costs #employeebenefits #employeebenefitslaw #ERISA #employeebenefitslawyer #ERISAlawyer #legalnews #lawnews #oklaw #mcafeetaft #lawfirm

Compliance Wednesday!!!! Did you know that a recent court decision by the U.S. District Court for the District of Columbia struck down a 2021 #HHS rule that allowed insurers to exclude the value of a drug manufacturer's coupon toward an individual's OOP costs? Yes? No? :) The court’s decision changes how some group health plans will credit participants’ use of drug manufacturer coupons. From the latest issue of Directions, catch up on the court's decision and its impact for prescription drug plans ➡️ https://lnkd.in/etthptjf #ComplianceConsulting #EmployeeBenefits #OrganizationalWellbeing #ComplianceDirections

DID You Know ThAt Lawmakers this year have introduced more than 170 bills in 41 states seeking to regulate PBMs? Such middlemen/3rd parties which manage prescription drug benefits for health plans and employers negotiate contracts with drugmakers, insurers, and pharmacies.  Trade groups that represent independent pharmacies are among those lobbying hardest for state legislation to regulate a practice known as spread pricing. Eyes are currently focused on California and Massachusetts, where bills are still pending. Measures in > 30 states — 1/3rd have been signed into law — include provisions to increase the reimbursements PBMs give to pharmacies for purchasing and dispensing medications, and prohibit the middlemen from steering patients away from independent pharmacies. Bloomberg News Government   @JonReid "States of Play" #employeebenefits #commercialinsurance

3 things to know about PBM's Recently the state of Idaho passed legislation regulating PBM's (pharmacy benefit managers). Many other states are looking at similar legislation as PBM reform has stalled at the federal level. Idaho's law focuses on the following three areas: 👉 Requirement to use "pass-through”pricing: eliminates spread pricing where the PBM pays the pharmacy one amount and charges the employer group a marked up amount pocketing the margin) 👉100% "pass through" of manufacturer rebates: many PBM's pocket some or all of the rebates offered by manufacturers. rebates are problematic as it offers a financial incentive to push expensive drugs. This will eliminate that. 👉Network Adequacy: PBM's must include network adequacy requirements that meets or exceeds Medicare Part D program standards which will require availability of a network not limited to pharmacies affiliated with the PBM. There's more to the law, but these are the three important takeaways. I think we will see legislation pass at the federal level in the next five years. Prescription costs are becoming such a large part of medical trend, the demand for reform is only getting louder. Let me know if you want to discuss. #aaronsharin #pharmacybenefitmanagers #employeebenefits

Could we make this more complicated for employer-sponsored plans? A recent court decision by the U.S. District Court for the District of Columbia struck down a 2021 #HHS rule that allowed insurers to exclude the value of a drug manufacturer's coupon toward an individual's OOP costs? The court’s decision changes how some group health plans will credit participants’ use of drug manufacturer coupons. From the latest issue of Directions, catch up on the court's decision and its impact for prescription drug plans ➡️ https://lnkd.in/etthptjf #ComplianceConsulting #EmployeeBenefits #OrganizationalWellbeing #ComplianceDirections

Medicare beneficiaries will see more changes to the Medicare prescription drug (Part D) program in 2024, thanks to the Inflation Reduction Act signed into law last August. https://ow.ly/Oepz50QgwCY #medicare #health #medicarepartd

State level legislation remains hot against PBM practices in 2024. Latest Bloomberg summary shows progress has been made, but commercial insured plans need to get engaged. Opportunities to explore more direct manufacturer and employer collaboration is one of our areas of interest - follow us at www.epcouncil.org.

It looks like Pharmacy Benefit Managers (PBMs) legislation will be on #PresidentBiden's desk by the end of this #legislativesession. Michael Ruggio shares what you need to know.