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New Rule May Reduce Medicare Advantage Drug Costs
Good news: Your out-of-pocket prescription drug costs under your Medicare Advantage plan may be coming down soon.
A recent change from the Center for Medicare Services (CMS) grants permission to Medicare Advantage plans to allow "step therapy" for Part B drugs.
Essentially, this allows plans to start patients on lower-cost generics, where appropriate. Patients would still be able to move to costlier name-brand drugs on Part B medications where the generics are not effective.
Part B drugs differ from Part D drugs in that Part B treatments are delivered in health care facilities and for drugs administered in doctors' offices, while Part D drugs are those that the consumer purchases from pharmacies. Step therapy has been routine for Part D plans for years, but has been prohibited for drugs administered in health care facilities.
The move by the CMS reverses a 2012 decision by the Health and Human Services Administration.
"By allowing Medicare Advantage plans to negotiate for physician-administered drugs like private-sector insurers already do, we can drive down prices for some of the most expensive drugs seniors use," Health and Human Services Secretary Alex Azar said.
Big savings possible
According to health industry sources, the decision could save as much as 23% on immunology treatments including Remicade, Simponi and Stelera, and ultimately allow competing Medicare Advantage plans to offer premium reductions beginning in 2019.
The Health and Human Services Department notes that private medical insurance companies implementing step therapy realized savings of 15 to 20%. A portion of any savings realized would be redistributed to beneficiaries, likely via rewards programs, rebates and gift card programs.
"As soon as next year, drug prices can start coming down for many of the 20 million seniors on Medicare Advantage, with more than half of the savings going to patients," Azar said. "Consumers will always retain the power to choose the plan that works for them: If they don't like their plan, they don't have to keep it."
Step therapy for Part B drugs can begin on new prescriptions beginning in 2019. We'll be monitoring Medicare Advantage prices as they adjust to the news and begin announcing their prices for 2019 and 2020.
Doctors' groups have noted some potential downsides to the decision: Requiring patients to try generics first before authorizing brand name drugs could cause effective treatment delays, as the process requires patients to put off taking more effective chemotherapies or other drug regimens.
The CMS is restricting the step therapy directive to new prescriptions only. So, if you're currently taking a more expensive brand name medication, you won't have to stop taking your current drug in order to see if the generic is effective for you. You can keep taking your current medication.
However, if you develop a new medical condition, your Medical Advantage plan may need to start with a generic before your plan would authorize the more expensive drug.
If a physician believes that step therapy would be inappropriate and ineffective for a patient, and there is a medical necessity for the patient to proceed directly to a more expensive drug, bypassing the step therapy process, they are to use the appeal procedure established by the plan.
Not all plans will be participating in the step therapy program. If you want to switch to a Medicare Advantage plan that does or does not participate in step therapy, call us before or during the Medicare Advantage open enrollment period of October 15 to December 7. We'll be able to help you assess your needs and choose the plan that's best for you.
Call your agent today to discuss this further, 314-351-HALO(4256).
Even Small, Mid-sized Firms Need a Crisis Management Plan
With risks to companies and employees growing, sometimes the unthinkable happens and a business has a real crisis on its hands.
While large companies are usually well-prepared for a crisis should one occur, most small and mid-sized firms don't have the resources or have not put much thought into how they would handle a crisis. One of the most difficult parts of crisis planning is that you will often not know what you are planning for as a crisis could be a number of different events, like:
The sudden death of a key member of your team could lead to operational issues.
A defective product leads to an injury, illness - or worse.
An accident severely maims or kills a number of your workers.
To get started, assemble a team that includes key members from your organization who will be responsible for creating your crisis-response plan. Inc. Magazine recommends the following for your team:
Make a plan - You cannot start planning without first identifying your objectives. Once you identify them, you can make response plans for each type of event. Typically, that includes:
Safeguarding any person (employee, vendor, customer and/or the public) who may be affected by the crisis. Your plan would include how to respond to the crisis if people's health and wellness at stake.
Making sure the organization survives. This would include steps you would take to ensure the company can continue as a going concern after a significant disruption.
Keeping stakeholders (employees, vendors, clients, the public and government) informed on developments.
The plan should take into account how a crisis would affect your main stakeholders:
Your company's value and reputation.
Create a succession plan - You should clearly outline the necessary steps to follow if you or one of your key managers suddenly became unable to perform their duties. This plan may include selling the company, or transferring ownership to family members or key employees.
Seek advice from the experts - This includes your leadership team, employees, customers, communications experts, investment bankers, exit planners, lawyers and financial managers. Each of these individuals has unique insights that can be invaluable for how to tackle a crisis.
Name a spokesperson - This is important if you have a crisis that spreads beyond your organization and affects the health and safety of a member of the general public, your staff or customers. This kind of crisis could attract media coverage and your organization needs to be ready to respond if that happens.
Funneling all media communications through a spokesperson can help you deliver a clear and consistent message to media, as well as to the public at large.
Honesty is the best policy - Lie or hide details at your own risk. A lack of honesty and transparency can lead to rumors, as well as a general distrust of your organization if the truth is exposed. The best approach is to be transparent and truthful about what happened and what you are doing to resolve the crisis.
Keep your staff up to speed - Besides transparency with outside people, it's crucial that you don't keep your employees in the dark after a crisis has hit. Again, to stop the rumor mill and also keep employees from becoming worried amidst the uncertainty, keep your workers abreast of developments - and what the crisis means for the organization, and what you are doing about it. Put together a plan for keeping staff up to date.
Keep customers and suppliers informed - If you have an event that's causing some disruptions, you also owe it to your clients and vendors to let them know what's happening. Don't let them find out from the media. Like your employees, keep them regularly updated on events and the steps you are taking to address the crisis. Put together a plan for how you would keep them posted.
Act fast and update regularly - Keeping the communications alive is important and once you grasp the situation and its effects, you can issue summary statements of the crisis and what's happened. Then you can follow up with regular updates on your action plans, on people affected, any hotline you may set up, and more.
These days news travels fast and like wildfire on social media. You need to move at the same pace.
Social media is vital - More and more people get their news from social media and the discussions that ensue on posts, so you need to make sure that your company stays on top of the flow. You may want to assign a person or two to monitor social media and post and react to posts on social media. That way, your team can tell the company's side of the story and put to rest unfounded rumors.
Make a plan for what a social media contact's responsibilities would be during a crisis.
Get an early start
Your plan won't be effective if you create it during a crisis. Plan in advance, so everyone can approach the strategizing unrushed and with a clear head.
Homeowners Insurance & Social Gatherings
Many homeowners enjoy throwing parties for holidays or special events. If a party is in the near future, be sure that individual homeowners coverage is adequate. Guests who are injured may need to file an injury claim if their vehicle is damaged, if they fall down or if a pet bites them. Research shows that about 75 percent of adult homeowners who plan social gatherings in their homes do not have a personal umbrella policy.
This makes them more vulnerable to lawsuits stemming from guests who suffer injuries. The same research study showed that the remainder of the homeowners surveyed did not know what type of coverage they had. This means it is likely that the percentage of homeowners who do not have adequate coverage is more than 75 percent. However, they should have this extra coverage to protect themselves from lawsuits. Although dog bites and falls are common, alcohol is one liability issue that is often overlooked but is very risky.
Alcoholic drinks are viewed as a way to relax and enjoy socializing. However, there is one sobering fact that many homeowners who plan to serve these drinks should know. In 30 states, homeowners may be responsible for damages arising from any auto accidents caused by their intoxicated guests who choose to drive home. In a research survey, more than 50 percent of homeowners said they agreed that party hosts should be responsible for their guests' safety. However, very few took any steps to obtain adequate insurance coverage. The research study concluded that most people avoid purchasing a personal umbrella policy because they are under the impression that their regular homeowners coverage provides adequate protection for such matters. Since many lawsuits include large awards and medical costs, it is easy for one incident to exceed the homeowners liability limits.
Homeowners must take two steps to ensure they are protected. First, it is imperative for them to contact a personal agent to discuss umbrella policy options. It is also important to take the agent's advice to avoid facing a costly lawsuit. The second step homeowners must take is to read the following suggestions, which are designed to reduce their risk of lawsuits from intoxicated party guests:
-Instead of having the party at a personal residence, reserve space in a restaurant or bar that has a liquor license.
-Ensure that there are filling food options and non-alcoholic beverage choices available.
-To avoid trouble from party-crashing strangers, limit invitations to friends or familiar people.
-For guests who appear drunk, provide transportation or overnight accommodations.
-Avoid serving alcohol to guests who appear intoxicated.
-Plan activities that draw attention away from drinking alcohol.
-If several guests are expected at a home party, consider hiring an off-duty police officer to handle problems and discreetly monitor guests' alcohol consumption.
-Take away all alcoholic drinks at least one hour before the party is supposed to end.
What is the Difference Between Policy Cancellation and Policy Non-Renewal?
In some policyowners’ minds, whether your insurance company cancels your auto coverage, or simply chooses not to renew it, it all means the same - you're suddenly without insurance. However, it isn’t quite that simple. The difference between cancellation and non-renewal can be a significant factor in finding another auto insurance policy.
There are specific conditions, outlined in each state’s laws, under which an auto insurer is permitted to cancel your policy. Here are some common ones:
Failing to pay your premium in a timely manner.
Losing your ability to drive because your license was suspended or revoked, or because it expired during the term of the policy. This can also apply to any members of your family who are covered under the policy.
Falsifying information on your insurance application.
Your insurer has the right to cancel your policy at any time if you’re guilty of one of these actions. If it decides to do so, it must send you a written notice of the cancellation that explains why your coverage is being cancelled. Depending on the laws of your state, your insurer must provide 10 to 30 days notice before the cancellation becomes effective.
There is one other instance where an insurer has the right to cancel your coverage, and that is during the 60 day binding period immediately following your application. An insurer could cancel your policy during this time if it discovers some information that marks you as an unacceptable risk.
If your auto insurance is cancelled for any reason, you will likely have trouble finding another insurance company willing to issue you a policy. The only cancellation circumstance where the possibility of reinstatement exists, is being cancelled for not paying your premium.
In this case, you would be sent a letter informing you that your premium was not received and providing a specific amount of time to rectify the situation. If the payment is received before the cancellation date, you will receive a letter of reinstatement. However, reinstatement does carry consequences. You will probably have to pay a late fee and an extra premium to cover the period between the cancellation and the reinstatement.
You auto insurer can also elect not to renew your policy. State laws aren’t always as specific about what constitutes reasons for non-renewal as they are about reasons for cancellation.
If your insurer decides not to renew, it is usually because you filed too many claims for at fault accidents, were convicted of driving under the influence, or were cited for too many traffic violations during the previous three to five years.
As is the case with cancellation, your auto insurer has between 10 to 30 days to send written notice of non-renewal, which should explain the reason they chose not to renew. If this isn’t included in your non-renewal notice, request an explanation from your insurer. The one advantage non-renewal has over cancellation is that it is less of a deterrent in finding another company to provide you with auto coverage.
To learn more talk with an agent, today at 314-351-HALO(4256)