No mat needed: Yoga at your desk

A sticky mat seems de rigueur for modern-day yogis, but that doesn’t mean a long piece of rubber is required to take part in the ancient practice.

Yoga first and foremost is about being present, and it starts with attentive breathing. You can do that anywhere and without props.

Once you’ve got the hang of steady breathing, matching inhales and exhales to movements helps your body relieve tension and your muscles wake up. In fact, the key to the physical practice of yoga is matching conscious breath to movement. It’s also a big part of what makes yoga feel great. Without it, you’d be doing calisthenics.

We’ve rounded up a few yoga exercises you can do easily and safely at work. All require standing – good news, given sitting is pretty bad for us. It’s best to do them with your feet flat on the ground.

 

Stand with your feet hip-distance apart. Inhale as you bring your arms overhead. Keep your chin level with the ground. Exhale as you soften your knees and twist your torso to the right, letting your head follow and dropping your arms to shoulder-height. Inhale as you turn back to center, lifting your arms overhead. Do the twist to the left. Repeat this pattern several times.

Benefits: Strengthens abdominal muscles, shoulders and upper arms. Stretches back and chest. Lubricates joints of the spine, including in the neck, and shoulders.

Chair

Stand with your feet hip-distance apart, arms at your sides. Inhale as you lift the crown of your head. Exhale as you bend your knees (typically you want to track each knee over the middle of its corresponding foot), like you’re sitting back in a chair. Hinge at your hips, tilting your torso forward up to 45 degrees. Lift your arms to a comfortable height. Inhale as you return to standing, crown lifted, arms lengthening down. Repeat several times.

Benefits: Strengthens front thighs, buttocks, core, upper back and upper arms. Stretches calves and side torso. Lengthens spine. Lubricates joints of the ankles, knees, hips and shoulders.

Triangle

Stand with your feet slightly wider than hip-distance apart, toes pointing same direction as your chest, then turn your right foot 90 degrees to the right, and your left foot about 15 degrees to the right, making sure your left toes point the same direction as your left knee. Inhale as you extend your arms out from the shoulders and lengthen your spine. Exhale as you tilt your torso to the right, releasing your right arm toward your right leg and your left arm up to a comfortable height. Don’t turn your chest toward your right leg. Drop your gaze to the ground if you feel tension in your neck. Hold for several breaths, and repeat with the left leg.

Benefits: Strengthens front thighs, buttocks, side torso and neck. Stretches calves, back thighs and side torso. Lubricates joints of the hips and shoulders.

 

 

You can read the original article here.

Source:
Malek M. (2 May 2017). "No mat needed: Yoga at your desk" [Web blog post]. Retrieved from address http://worklife.coloniallife.com/2017/05/no-mat-needed-yoga-desk/?utm_sq=flegx3i374&utm_source=Twitter&utm_medium=social&utm_campaign=WorkLifeTweets&utm_content=Articles


Two Months After Hurricane Maria, A Growing Majority Of Americans Say Puerto Ricans are Not Yet Getting the Help They Need

Two months after Hurricane Maria struck Puerto Rico, a growing majority of Americans say that Puerto Ricans affected by the devastating storm are not yet getting the help they need, the November Kaiser Family Foundation Tracking Poll finds.

This month, 70 percent of the public say that people in Puerto Rico are not yet getting the help they need, up from 62 percent in October 2017. These perceptions vary by party, and half of Republicans (52%) now say Puerto Ricans aren’t yet getting needed help, up significantly from October (38%).

When asked whether the federal government is doing enough to restore electricity and access to food and water in Puerto Rico or not, a majority of the public (59%) says the federal government is not doing enough, up from 52 percent in October. Most Democrats (86%) and independents (59%) say the federal government is not doing enough, but most Republicans (63%) say it is doing enough.

In contrast, Americans see the recovery efforts in Texas following Hurricane Harvey in late August progressing more positively. Most (60%) of the public says Texans are getting the help they need, twice the share (31%) who say Texans aren’t yet getting needed help.

puertoricopoll.png

The poll finds similar shares of Americans they are closely following news about recovery efforts in Puerto Rico (63%) and in Texas (58%).  Democrats are somewhat more likely to report closely following news about the Puerto Rico recovery (75%) than are independents (61%) and Republicans (54%). In contrast, there are no partisan differences for those following news about Texas.

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from November 8 – 13, 2017 among a nationally representative random digit dial telephone sample of 1,201 adults. Interviews were conducted in English and Spanish by landline (415) and cell phone (786). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

 

You can read the original article here.

Source:

Kaiser Family Foundation (20 November 2017). "Two Months After Hurricane Maria, A Growing Majority Of Americans Say Puerto Ricans are Not Yet Getting the Help They Need" [Web blog post]. Retrieved from address https://www.kff.org/other/press-release/poll-two-months-after-hurricane-maria-a-growing-majority-of-americans-say-puerto-ricans-are-not-ye-getting-the-help-they-need/

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How employers can better support the caregivers in their workforces

How can you provide the best support for the caregivers in your workforce? From Employee Benefit News, this article discusses the responsibilities caregiving employees juggle, and why it's so important for employers to take those responsibilities into consideration when creating a healthy and stable work environment.


As more employees self-identify as caregivers for family members and friends, employers are starting to address the needs of workers who struggle to balance work while caring for others.

The numbers are staggering. One in six U.S. employees identify as a caregiver for a family member or friend, according to research by Family Caregiver Alliance. An AARP study found that U.S. businesses lose more than $25 billion annually in lost productivity due to absenteeism among full-time working caregivers, and that figure grows an additional $3 billion when part-time workers with caregiving duties are accounted for.

“Of today’s 40 million family caregivers, 24 million are juggling caregiving responsibilities and employment. By recognizing and supporting their needs, employers can improve productivity and foster a stable and healthy workforce,” says Nancy LeaMond, chief advocacy and engagement officer for AARP.

With that in mind, Northeast Business Group on Health and AARP have released a resource guide for employers who wish to ease the burden of the caregivers among their workforce. According to Supporting Caregivers in the Workplace: A Practical Guide for Employers, the authors recommend that employers create a corporate culture of awareness, draft workplace policies, benefits and programs, obtain the support of top executives and implement new services throughout the work force.

The guide also suggests employers offer paid sick days that can also be used for the care of a relative; in-house stress-reduction programs such as yoga, meditation; massage discounts and online or in-person coaching to assist in developing a care plan. Employers are also urged to offer digital tools to help employees manage their caregiving duties and provide legal and financial counseling for employees.

Employees who are preoccupied with the care and wellbeing of a parent, sibling or child have an impact on the workplace in both their quality of work and in potential medical claims.

“Trying to balance those responsibilities however large or small does have ramifications for the folks who are doing the caregiving,” says Candace Sherman, interim CEO of NEBGH. She says caregivers often feel lonely and isolated due to the demands placed on them and they often experience depression and anxiety when dealing with their caregiving roles.

“They're often spending their outside-of-work time providing care as opposed to socializing and oftentimes they neglect their own mental and physical well-being in favor of making sure that whomever they're caring for has what they need,” says Sherman. “Ultimately, that shows up in healthcare claims down the road.”

Fighting the stigma

By creating a culture of awareness around caregiver needs and responsibilities, employers may shake the resistance employees feel when identifying as caregivers.

“We found that there's a bit of a stigma in terms of folks raising their hand and saying ‘I'm a caregiver and I'm having some trouble,’” says Sherman. She adds that this impulse is similar to employees’ overall reluctance to admitting that they have a mental health issue.

“Employee caregivers might worry that if their colleagues know they're caring for someone, their manager will think ‘I've got this great new assignment but this person's overburdened right now,’” she says. “Or maybe they're up for a promotion and they feel they won't be considered because people know that they have other responsibilities outside of work.”

The caregiving guide recommends employers “ensure that managers at all levels are aware of the company’s policies regarding flex-time, leave policies and other benefits that caregiving employees can access, and should encourage them to openly support employees using these benefits.”

The guide also recommends that providing paid leave to these employees “might be the single most important consideration for employers when thinking about creating a caregiving-friendly workplace.”

Benefit administrators appear to be getting the message. Respondents of a July 2017 survey of benefits executives and managers from roughly 130 companies said that if they could roll out “two new policies, programs or benefits tomorrow to support caregivers, they would expand leave policies and coaching, wellness or support services designed to support caregiver well-being.”

The burden is not just on employers to act to improve the workplace for caregivers, they have to come to terms with their duties and the impact it has on their personal and work lives, says Sherman. Caregivers are slow to identify themselves as such because of cultural and societal roles that engrain our sense of family responsibilities.

“We have all been there or we’re close to people who have been there in terms of caring for someone who's ill or elderly. We are ingrained to view it as we're caring people and this is just something that we do, so people don't self-identify as caregivers,” Sherman says.

She adds, “But if you're a caregiver and you're balancing those responsibilities, they can range from checking in with a family member a couple of times a week or making a run for groceries or medications to much more intensive duties that occupy several hours a day.”

 

You can read the original article here.

 

Source:

Albinus P. (5 November 2017). "How employers can better support the caregivers in their workforces" [Web Blog Post]. Retrieved from address https://www.benefitnews.com/news/how-to-meet-the-needs-of-caregiver-employees?feed=00000152-18a5-d58e-ad5a-99fd665c0000


New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women


You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/

The Trump Administration has issued new regulations that significantly broaden employers’ ability to be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  The regulation opens the door for any employer or college/ university with a student health plan with objections to contraceptive coverage based on religious beliefs to qualify for an exemption. Any nonprofit or closely-held for-profit employer with moral objections to contraceptive coverage also qualifies for an exemption. Their female employees, dependents and students will no longer be entitled to coverage for the full range of FDA approved contraceptives at no cost.

On October 6, 2017, the Trump Administration issued two new regulations greatly expanding the types of employers that may be exempt from the Affordable Care Act’s (ACA) contraceptive coverage requirement.  These regulations are a significant departure from the Obama-era regulations that only granted an exception to houses of worship.  One of the regulations allows nonprofits or for-profit employer with an objection to contraceptive coverage based on religious beliefs to qualify for an exemption and drop contraceptive coverage from their plans.  The other regulation also exempts all but publicly traded employers with moral objections to contraception from rule. These new policies, effective immediately, also apply to private institutions of higher education that issue student health plans. The immediate impact of these regulations on the number of women who are eligible for contraceptive coverage is unknown, but the new regulations open the door for many more employers to withhold contraceptive coverage from their plans.

New regulations from the Trump administration greatly expand exemption from #ACA contraceptive coverage rule

Contraceptive coverage under the ACA has made access to the full range of contraceptive methods affordable to millions of women. This provision is part of a set of key preventive services that has been identified by the Health Resources and Services Administration (HRSA) for women that must be covered without cost-sharing. Since it was first issued in 2012, the contraceptive coverage provision has been controversial. While very popular with the public, with over 77% of women and 64% of men reporting support for no-cost contraceptive coverage, it has been the focus of litigation brought by religious employers, with two cases (Zubik v Burwell and Burwell v Hobby Lobby)  reaching the Supreme Court. This brief explains the contraceptive coverage rule under the ACA, the impact it has had on coverage, and how the new regulations issued by the Trump Administration change the contraceptive coverage requirement for employers and affect women’s coverage.

How do the new regulations change contraceptive coverage requirements for employers?

Since they were announced in 2011, the contraceptive coverage rules have evolved through litigation and new regulations. Most employers were required to include the coverage in their plans. Houses of worship could choose to be exempt from the requirement if they had religious objections. This exception meant that women workers and female dependents of exempt employers did not have guaranteed coverage for either some or all FDA approved contraceptive methods if their employer had an objection. Religiously affiliated nonprofits and closely held for-profit corporations were not eligible for an exemption, but could choose an accommodation. This option was offered to religiously affiliated nonprofit employers and then extended to closely held for-profitsafter the Supreme Court ruling in Burwell v. Hobby Lobby. The accommodation allowed these employers to opt out of providing and paying for contraceptive coverage in their plans by either notifying their insurer, third party administrator, or the federal government of their objection. The insurers were then responsible for covering the costs of contraception, which assured that their workers and dependents had contraceptive coverage while relieving the employers of the requirement to pay for it.

As of 2015, 10% of nonprofits with 5,000 or more employees had elected for an accommodation without challenging the requirement. This approach, however, has not been acceptable to all nonprofits with religious objections.1 In May 2016, the Supreme Court remanded Zubik v. Burwell, sending seven cases brought by religious nonprofits objecting to the contraceptive coverage accommodation back to the respective district Courts of Appeal. The Supreme Court instructed the parties to work together to “arrive at an approach going forward that accommodates petitioners’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans receive full and equal health coverage, including contraceptive coverage.”2

On October 6, 2017, the Trump Administration issued new regulations greatly expanding eligibility for the exemption to all nonprofit and closely-held for-profit employers with objections to contraceptive coverage based on religious beliefs or moral convictions, including private institutions of higher education that issue student health plans (Figure 1).  In addition, publicly traded for-profit companies with objections based on religious beliefs also qualify for an exemption. There is no guaranteed right of contraceptive coverage for their female employees and dependents or students. Table 1 presents the changes to the contraceptive coverage rule from the Obama Administration in the new Interim Final regulations issued by the Trump Administration.

Figure 1: Employers Objecting to Contraceptive Coverage: Exemptions and Accommodations Under the Trump Administration Regulations

The accommodation will be available to employers that previously qualified for the accommodation.  They now will also have the choice of an exemption. The federal departments issuing the regulations posit that these new rules will have limited impact on the number of women losing contraceptive coverage.   However, it is not clear how many employers previously utilizing the accommodation will now opt for an exemption, resulting in the loss of contraceptive coverage for their employees and dependents.  In addition, there are also an unknown number of organizations that were not previously eligible for either the accommodation or exemption that may now opt for an exemption. These new regulations create two new categories of employers who can now qualify for an exemption or can voluntarily chooses an accommodation:  1) publicly traded for-profit companies with a religious objection and 2) nonprofit and closely held for-profit employers who have a moral objection to contraceptives, a considerably larger pool of employers than when the exemption was available only to those who were employees of a house of worship or who were eligible for an accommodation in the past.

Table 1: Summary of Changes in the Contraceptive Coverage Regulations for Objecting Entities
  Obama Administration
August 2012 to October 5, 2017
Trump Administration
Effective October 6, 2017
What types of contraceptives must plans cover without cost-sharing? At least one of each of the 18 FDA approved contraceptive methods for women, as prescribed, along with counseling and related services must be covered without cost-sharing. No change
Are any employers “exempt” from the contraceptive mandate?
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • No notice to employees is required. Women workers and female dependents must pay for their own contraceptives.
  • Religious institutions defined as “houses of worship”
  • Grandfathered plans
  • Nonprofit or  for-profit employers (including publicly traded companies), insurers, or private colleges or universities that issue student insurance plans with a religious objection to contraceptive coverage
  • Nonprofit or closely held for-profit employers, insurers, or private colleges or universities that issue student insurance plans with a moralobjection to contraceptive coverage
  • Notice is only required if the plan previously included contraceptive coverage. Women workers and female dependents must pay for their own contraceptives.
Who pays for contraceptive coverage for employees of organizations receiving an exemption?
  • The cost of contraceptives is borne by women workers and female dependents.
  • There is no guarantee of contraceptive coverage for employees of an exempt organization.
  • The employer may choose to cover some methods, but has no obligation to cover all 18 FDA methods without cost sharing
No change

What type of employers may seek an “accommodation” to avoid paying for contraceptives in their plans?  
  • Closely held for-profit corporations and religiously affiliated nonprofits with religious objections to contraception can opt out of providing and paying for contraceptive coverage
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
  • Any entity (except for houses of worship) eligible for an exemption can choose the accommodation instead of the exemption.
  • Notice must be provided to either their insurer, third party administrator, or the federal government of their objection.
  • Women workers and female dependents receive no cost contraceptive coverage.
Who pays for contraceptive coverage for employees of organizations receiving an accommodation?
  • Insurance companies of firms obtaining an accommodation must pay for contraceptive coverage.
  • Third-party administrators (TPA) of self-funded health plans must cover the costs of contraceptives for employees. The costs of the benefit are offset by reductions in the fees the TPA pays to participate in the federal exchange.
No change
When can entities change from an accommodation to an exemption? N/A
  • When an employer or private college or university currently using the accommodation opts for an exemption, the revocation of contraceptive coverage will be effective on the first day of the first plan year that begins 30 days after the date of the revocation or 60 days notice may be given in a summary of benefits statement.
  • The issuer or third party administrator is responsible for providing the notice to the beneficiaries.

How has the contraceptive coverage rule affected women?

Contraceptive use among women is widespread, with over 99% of sexually-active women using at least one method at some point during their lifetime.3 Contraceptives make up an estimated 30-44% of out-of-pocket health care spending for women.4 Since the implementation of the ACA, out-of-pocket spending on prescription drugs has decreased dramatically (Figure 2). The majority of this decline (63%) can be attributed to the drop in out-of-pocket expenses on the oral contraceptive pill for women.5 One study estimates that roughly $1.4 billion dollars per year in out-of-pocket savings on the pill resulted from the ACA’s contraceptive mandate.6  By 2013, most women had no out-of-pocket costs for their contraception, as median expenses for most contraceptive methods, including the IUD and the pill, dropped to zero.7

Figure 2: The Contraceptive Coverage Policy Has Had a Large Impact on Out-Of-Pocket Spending in a Short Amount of Time

This provision has also influenced the decisions women make in their choice of method. After implementation of the ACA contraceptive coverage requirement, women were more likely to choose any method of prescription contraceptive, with a shift towards more effective long-term methods.8  High upfront costs of long-acting methods, such as the IUD and implant, had been a barrier to women who might otherwise prefer these more effective methods.  When faced with no cost-sharing, women choose these methods more often9, with significant implications for the rate of unintended pregnancy and associated costs of childbirth.10

Finally, decreases in cost-sharing were associated with better adherence and more consistent use of the pill. This was especially true among users of generic pills.  One study showed that even copayments as low as $6 were associated with higher levels of discontinuation and non-adherence,11 increasing the risk of unintended pregnancy.

Do states with no-cost contraceptive coverage laws allow exemptions to objecting entities?

The federal standards under Affordable Care Act created a minimum set of preventive benefits that applied to most health plans regulated by the federal government (self-funded plans, federal employee plans) and states (individual, small and large group plans), including contraceptive coverage for women with no cost-sharing.  States have also historically regulated insurance, and many have had mandated minimum benefits for decades. State laws, however, have more limited reach in that they only apply to state regulated fully insured plans, do not have jurisdiction over self-funded plans, where 61% of covered workers are insured.12 In self-funded plans, the employer assumes the risk of providing covered services and usually contracts with a third party administrator (TPA) to manage the claims payment process. These plans are overseen by the Federal Department of Labor under the Employer Retirement Income Security Act (ERISA) and are only subject to federally established regulations.13  The ACA sets a minimum standard of coverage for preventive services for all plans. However, state laws regulating insurance, including contraceptive coverage, can require fully insured plans to provide coverage beyond the federal standards.

Eight states have strengthened and expanded the federal contraceptive coverage requirement (CA, IL, MD, ME, NV, NY, OR, VT).  Another 20 states have contraceptive equity laws that require plans to cover contraceptives if they also provide coverage for prescription drugs but they do not necessarily require coverage of all FDA-approved contraceptives or ban cost-sharing (Figure 3).

Figure 3: Many States Have Contraceptive Coverage Requirements

Many of the 28 states that have passed contraceptive coverage laws (both equity and no-cost coverage) have a provision for exemptions, but the laws vary from state to state and only apply to fully insured plans.  This means that there may be a conflict between the state and federal requirements when it comes to religious exemptions.  In some states with a contraceptive coverage requirement, some employers who are eligible for an exemption under federal law will not qualify for an exemption under state law (Table 2). Employers in those states will have to have to meet the standards established by their state even though they may qualify for an exemption based on the new federal regulations.  This conflict may set the stage for future litigation.

Table 2: State Requirements for No-Cost Contraceptive Coverage
StateDate Effective Applies to Coverage required without cost sharing Exemptions allowed
  Private plans Medicaid With RX all FDA approved OTC Vasectomy Religious Moral
CaliforniaJanuary 2015 X MCOs X Narrowly defined nonprofit religious employers None
IllinoisJanuary 2017 X X X
except male condoms
Any employer, or insurer with a religious objection Any employer, or insurer with a moral objection
MarylandJanuary 2018 X X X X X Religious organizations if the coverage conflicts with the organization’s bona fide religious beliefs and practices None
MaineJanuary 2019 X X Narrowly defined nonprofit religious employers None
NevadaJanuary 2018 X X X Insurers affiliated with a religious organization None
New YorkAugust 2017 X X Narrowly defined nonprofit religious employers* None
OregonAugust 2017 X X X Narrowly defined nonprofit religious employers None
VermontOctober 2016 X X – and all other public health assistance programs X X None None
NOTES: *Requires the insurer to offer a rider to policyholders so that women will have contraceptive coverage.
SOURCE: Kaiser Family Foundation analysis of state laws and regulations.

Conclusion

The Trump Administration’s new regulations substantially expand the exemption to nonprofit and for-profit employers, as well as to private colleges or universities with religious or moral objections to contraceptive coverage. It is unknown how many of these employers and colleges will maintain coverage through the accommodation as before and how many will now opt for the exemption leaving their students, employees and dependents without no-cost coverage for the full range of contraceptive methods. As a result of the new regulation, choices about coverage and cost-sharing will be made by employers and private colleges and universities that issue student plans. For many women, their employers will determine whether they have no-cost coverage to the full range of FDA approved methods.  Their choice of contraceptive methods may again be limited by cost, placing some of the most effective yet costly methods out of financial reach.

You can read the original article here.

Source:

Sobel L., Salganicoff A., Rosenzweig C. (6 October 2017). "New Regulations Broadening Employer Exemptions to Contraceptive Coverage: Impact on Women" [Web Blog Post]. Retrieved from address https://www.kff.org/womens-health-policy/issue-brief/new-regulations-broadening-employer-exemptions-to-contraceptive-coverage-impact-on-women/


CenterStage...Open Season for Open Enrollment

In this month’s CenterStage, we interviewed Rich Arnold for some in-depth information on Medicare plans and health coverage. Read the full article below.

Open Season for Open Enrollment: What does it mean for you?

There are 10,000 people turning 65 every single day. Medicare has a lot of options, causing the process to be extremely confusing. Rich – a Senior Solutions Advisor – works hard to provide you with the various options available to seniors in Ohio, Kentucky and Indiana and reduce them to an ideal, simple, and easy-to-follow plan.

“For me, this is all about helping people.”
– Rich Arnold, Senior Solutions Advisor

What does this call for?

To provide clients with top-notch Medicare guidance, Rich must analyze their current doctors and drugs for the best plan option and properly educate them to choose the best program for their situation and health. It’s a simple, free process of evaluation, education, and enrollment.

For this month’s CenterStage article, we asked Rich to break down Medicare for the senior population who are in desperate need of a break from the confusion.

Medicare Break Down

Part A. Hospitalization, Skilled Nursing, etc.

If you’ve worked for 40 quarters, you automatically obtain Part A coverage.

Part B. Medical Services: Doctors, Surgeries, Outpatient visits, etc.…

You must enroll and pay a monthly premium.

Part C. Medicare Advantage Plans:

Provides most of your hospital and medical expenses.

Part D.

Prescription drug plans available with Medicare.

Under Parts A & B there are two types of plans…

Supplement Plan or Medigap Plan

A Medicare Supplement Insurance (Medigap) policy can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles, coverage anywhere in the US as well as travel outside of the country, pay a monthly amount, and usually coupled with a prescription drug plan.

Advantage Plan

A type of Medicare health plan that contracts with Medicare to provide you with all your Part A and Part B benefits generally through a HMO or PPO, pay a monthly amount from $0 and up, covers emergency services, and offers prescription drug plans.

How does this effect you?

Medicare starts at 65 years of age, but Rich advises anyone turning 63 or 64 years of age to reach out to an advisor, such as himself, for zero cost, to be put onto their calendar to follow up at the proper time to investigate the Medicare options.  Some confusion exists about Medicare and Social Security which are separate entities.  Social Security does not pay for the Supplement or Advantage plans.

Medicare Open Enrollment: Open Enrollment occurs between October 15th and December 7 – yes, right around the corner! However, don’t panic, Rich and his services can help you if you are turning 65 or if you haven’t reviewed your current plan in over a year – you should seek his guidance.

Your plan needs to be reviewed every year to best fit your needs. If you’re on the verge of 65, turning 65 in the next few months, or over 65, you should consult your Medicare advisor as soon as possible. For a no cost analysis of your needs contact Rich, Saxon Senior Solutions Advisor, rarnold@gosaxon.com, 513-808-4879.


The Medicare Part D Prescription Drug Benefit

Below we have an article from the Kaiser Family Foundation providing detailed information and graphics on the benefit of the Medicare Prescription Drug Plan.

You can read the original article here.


Medicare Part D is a voluntary outpatient prescription drug benefit for people on Medicare that went into effect in 2006. All 59 million people on Medicare, including those ages 65 and older and those under age 65 with permanent disabilities, have access to the Part D drug benefit through private plans approved by the federal government; in 2017, more than 42 million Medicare beneficiaries are enrolled in Medicare Part D plans. During the Medicare Part D open enrollment period, which runs from October 15 to December 7 each year, beneficiaries can choose to enroll in either stand-alone prescription drug plans (PDPs) to supplement traditional Medicare or Medicare Advantage prescription drug (MA-PD) plans (mainly HMOs and PPOs) that cover all Medicare benefits including drugs. Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. This fact sheet provides an overview of the Medicare Part D program and information about 2018 plan offerings, based on data from the Centers for Medicare & Medicaid Services (CMS) and other sources.

Medicare Prescription Drug Plan Availability in 2018

In 2018, 782 PDPs will be offered across the 34 PDP regions nationwide (excluding the territories). This represents an increase of 36 PDPs, or 5%, since 2017, but a reduction of 104 plans, or 12%, since 2016 (Figure 1).

Beneficiaries in each state will continue to have a choice of multiple stand-alone PDPs in 2018, ranging from 19 PDPs in Alaska to 26 PDPs in Pennsylvania/West Virginia (in addition to multiple MA-PD plans offered at the local level) (Figure 2).

Low-Income Subsidy Plan Availability in 2018

Through the Part D Low-Income Subsidy (LIS) program, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, or $18,090 for individuals/$24,360 for married couples in 2017) and modest assets (less than $13,820 for individuals/$27,600 for couples in 2017).1

In 2018, 216 plans will be available for enrollment of LIS beneficiaries for no premium, a 6% decrease in premium-free (“benchmark”) plans from 2017 and the lowest number of benchmark plans available since the start of the Part D program in 2006. Roughly 3 in 10 PDPs in 2018 (28%) are benchmark plans (Figure 3).

Low-Income Subsidy Plan Availability in 2018

Through the Part D Low-Income Subsidy (LIS) program, additional premium and cost-sharing assistance is available for Part D enrollees with low incomes (less than 150% of poverty, or $18,090 for individuals/$24,360 for married couples in 2017) and modest assets (less than $13,820 for individuals/$27,600 for couples in 2017).1

In 2018, 216 plans will be available for enrollment of LIS beneficiaries for no premium, a 6% decrease in premium-free (“benchmark”) plans from 2017 and the lowest number of benchmark plans available since the start of the Part D program in 2006. Roughly 3 in 10 PDPs in 2018 (28%) are benchmark plans (Figure 3).

Benchmark plan availability varies at the Part D region level, with most regions seeing a reduction of 1 benchmark plan for 2018 (Figure 4). The number of premium-free plans in 2018 ranges from a low of 2 plans in Florida to 10 plans in Arizona and Delaware/Maryland/Washington D.C.

Part D Plan Premiums and Benefits in 2018

Premiums. According to CMS, the 2018 Part D base beneficiary premium is $35.02, a modest decline of 2% from 2017.2 Actual (unweighted) PDP monthly premiums for 2018 vary across plans and regions, ranging from a low of $12.60 for a PDP available in 12 out of 34 regions to a high of $197 for a PDP in Texas.

Part D enrollees with higher incomes ($85,000/individual; $170,000/couple) pay an income-related monthly premium surcharge, ranging from $13.00 to $74.80 in 2018 (depending on their income level), in addition to the monthly premium for their specific plan.3 According to CMS projections, an estimated 3.3 million Part D enrollees (7%) will pay income-related Part D premiums in 2018.

Benefits. In 2018, the Part D standard benefit has a $405 deductible and 25% coinsurance up to an initial coverage limit of $3,750 in total drug costs, followed by a coverage gap. During the gap, enrollees are responsible for a larger share of their total drug costs than in the initial coverage period, until their total out-of-pocket spending in 2018 reaches $5,000 (Figure 5).

After enrollees reach the catastrophic coverage threshold, Medicare pays for most (80%) of their drug costs, plans pay 15%, and enrollees pay either 5% of total drug costs or $3.35/$8.35 for each generic and brand-name drug, respectively.

The standard benefit amounts are indexed to change annually by rate of Part D per capita spending growth, and, with the exception of 2014, have increased each year since 2006 (Figure 6).

Part D plans must offer either the defined standard benefit or an alternative equal in value (“actuarially equivalent”), and can also provide enhanced benefits. But plans can (and do) vary in terms of their specific benefit design, cost-sharing amounts, utilization management tools (i.e., prior authorization, quantity limits, and step therapy), and formularies (i.e., covered drugs). Plan formularies must include drug classes covering all disease states, and a minimum of two chemically distinct drugs in each class. Part D plans are required to cover all drugs in six so-called “protected” classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics.

In 2018, almost half (46%) of plans will offer basic Part D benefits (although no plans will offer the defined standard benefit), while 54% will offer enhanced benefits, similar to 2017. Most PDPs (63%) will charge a deductible, with 52% of all PDPs charging the full amount ($405). Most plans have shifted to charging tiered copayments or varying coinsurance amounts for covered drugs rather than a uniform 25% coinsurance rate, and a substantial majority of PDPs use specialty tiers for high-cost medications. Two-thirds of PDPs (65%) will not offer additional gap coverage in 2018 beyond what is required under the standard benefit. Additional gap coverage, when offered, has been typically limited to generic drugs only (not brands).

The 2010 Affordable Care Act gradually lowers out-of-pocket costs in the coverage gap by providing enrollees with a 50% manufacturer discount on the total cost of their brand-name drugs filled in the gap and additional plan payments for brands and generics. In 2018, Part D enrollees in plans with no additional gap coverage will pay 35% of the total cost of brands and 44% of the total cost of generics in the gap until they reach the catastrophic coverage threshold. Medicare will phase in additional subsidies for brands and generic drugs, ultimately reducing the beneficiary coinsurance rate in the gap to 25% by 2020.

Part D and Low-Income Subsidy Enrollment

Enrollment in Medicare drug plans is voluntary, with the exception of beneficiaries who are dually eligible for both Medicare and Medicaid and certain other low-income beneficiaries who are automatically enrolled in a PDP if they do not choose a plan on their own. Unless beneficiaries have drug coverage from another source that is at least as good as standard Part D coverage (“creditable coverage”), they face a penalty equal to 1% of the national average premium for each month they delay enrollment.

In 2017, more than 42 million Medicare beneficiaries are enrolled in Medicare Part D plans, including employer-only group plans.4 Of this total, 6 in 10 (60%) are enrolled in stand-alone PDPs and 4 in 10 (40%) are enrolled in Medicare Advantage drug plans. Medicare’s actuaries estimate that around 2 million other beneficiaries in 2017 have drug coverage through employer-sponsored retiree plans where the employer receives subsidies equal to 28% of drug expenses between $405 and $8,350 per retiree in 2018 (up from $400 and $8,250 in 2017).5 Several million beneficiaries are estimated to have other sources of drug coverage, including employer plans for active workers, FEHBP, TRICARE, and Veterans Affairs (VA). Yet an estimated 12% of Medicare beneficiaries lack creditable drug coverage.

Twelve million Part D enrollees are currently receiving the Low-Income Subsidy. Beneficiaries who are dually eligible, QMBs, SLMBs, QIs, and SSI-onlys automatically qualify for the additional assistance, and Medicare automatically enrolls them into PDPs with premiums at or below the regional average (the Low-Income Subsidy benchmark) if they do not choose a plan on their own. Other beneficiaries are subject to both an income and asset test and need to apply for the Low-Income Subsidy through either the Social Security Administration or Medicaid.

Part D Spending and Financing in 2018

The Congressional Budget Office (CBO) estimates that spending on Part D benefits will total $92 billion in 2018, representing 15.5% of net Medicare outlays in 2018 (net of offsetting receipts from premiums and state transfers). Part D spending depends on several factors, including the number of Part D enrollees, their health status and drug use, the number of enrollees receiving the Low-Income Subsidy, and plans’ ability to negotiate discounts (rebates) with drug companies and preferred pricing arrangements with pharmacies, and manage use (e.g., promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order). Federal law prohibits the Secretary of Health and Human Services from interfering in drug price negotiations between Part D plan sponsors and drug manufacturers.6

Financing for Part D comes from general revenues (78%), beneficiary premiums (13%), and state contributions (9%). The monthly premium paid by enrollees is set to cover 25.5% of the cost of standard drug coverage. Medicare subsidizes the remaining 74.5%, based on bids submitted by plans for their expected benefit payments. Part D enrollees with higher incomes ($85,000/individual; $170,000/couple) pay a greater share of standard Part D costs, ranging from 35% to 80%, depending on income.

According to Medicare’s actuaries, in 2018, Part D plans are projected to receive average annual direct subsidy payments of $353 per enrollee overall and $2,353 for enrollees receiving the LIS; employers are expected to receive, on average, $623 for retirees in employer-subsidy plans.7 Part D plans’ potential total losses or gains are limited by risk-sharing arrangements with the federal government (“risk corridors”). Plans also receive additional risk-adjusted payments based on the health status of their enrollees and reinsurance payments for very high-cost enrollees.

Under reinsurance, Medicare subsidizes 80% of drug spending incurred by Part D enrollees above the catastrophic coverage threshold. In 2018, average reinsurance payments per enrollee are estimated to be $941; this represents a 7% increase from 2017. Medicare’s reinsurance payments to plans have represented a growing share of total Part D spending, increasing from 16% in 2007 to an estimated 41% in 2018.8 This is due in part to a growing number of Part D enrollees with spending above the catastrophic threshold, resulting from several factors, including the introduction of high-cost specialty drugs, increases in the cost of prescriptions, and a change made by the ACA to count the 50% manufacturer discount in enrollees’ out-of-pocket spending that qualifies them for catastrophic coverage. Analysis from MedPAC also suggests that in recent years, plans have underestimated their enrollees’ expected costs above the catastrophic coverage threshold, resulting in higher reinsurance payments from Medicare to plans over time.

Issues for the Future

After several years of relatively low growth in prescription drug spending, spending has risen more steeply since 2013. The average annual rate of growth in Part D costs per beneficiary was 2.4% between 2007 and 2013, but it increased to 4.4% between 2013 and 2016, and is projected to increase by 4.7% between 2016 and 2026
(Figure 7).9

Medicare’s actuaries have projected that the Part D per capita growth rate will be comparatively higher in the coming years than in the program’s initial years due to higher costs associated with expensive specialty drugs, which is expected to be reflected in higher reinsurance payments to plans. Between 2017 and 2027, spending on Part D benefits is projected to increase from 15.9% to 17.5% of total Medicare spending (net of offsetting receipts).10 Understanding whether and to what extent private plans are able to negotiate price discounts and rebates will be an important part of ongoing efforts to assess how well plans are able to contain rising drug costs. However, drug-specific rebate information is not disclosed by CMS.

The Medicare drug benefit helps to reduce out-of-pocket drug spending for enrollees, which is especially important to those with modest incomes or very high drug costs. Closing the coverage gap by 2020 will bring additional relief to millions of enrollees with high costs. But with drug spending on the rise and more plans charging coinsurance rather than flat copayments for covered brand-name drugs, enrollees could face higher out-of-pocket costs for their Part D coverage. These trends highlight the importance of comparing plans during the annual enrollment period. Research shows, however, that relatively few people on Medicare have used the annual opportunity to switch Part D plans voluntarily—even though those who do switch often lower their out-of-pocket costs as a result of changing plans.

Understanding how well Part D is working and how well it is meeting the needs of people on Medicare will be informed by ongoing monitoring of the Part D plan marketplace and plan enrollment; assessing coverage and costs for high-cost biologics and other specialty drugs; exploring the relationship between Part D spending and spending on other Medicare-covered services; and evaluating the impact of the drug benefit on Medicare beneficiaries’ out-of-pocket spending and health outcomes.

Endnotes
  1. Poverty and resource levels for 2018 are not yet available (as of September 2017).

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  2. The base beneficiary premium is equal to the product of the beneficiary premium percentage and the national average monthly bid amount (which is an enrollment-weighted average of bids submitted by both PDPs and MA-PD plans). Centers for Medicare & Medicaid Services, “Annual Release of Part D National Average Bid Amount and Other Part C & D Bid Information,” July 31, 2017, available at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/PartDandMABenchmarks2018.pdf.

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  3. Higher-income Part D enrollees also pay higher monthly Part B premiums.

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  4. Centers for Medicare & Medicaid Services, Medicare Advantage, Cost, PACE, Demo, and Prescription Drug Plan Contract Report – Monthly Summary Report (Data as of August 2017).

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  5. Board of Trustees, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, Table IV.B7, available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2017.pdf.

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  6. Social Security Act, Section 1860D-11(i).

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  7. 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds; Table IV.B9.

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  8. Kaiser Family Foundation analysis of aggregate Part D reimbursement amounts from Table IV.B10, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

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  9. Kaiser Family Foundation analysis of Part D average per beneficiary costs from Table V.D1, 2017 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

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  10. Kaiser Family Foundation analysis of Part D benefits spending as a share of net Medicare outlays (total mandatory and discretionary outlays minus offsetting receipts) from CBO, Medicare-Congressional Budget Office’s June 2017 Baseline.

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Read the full article here.

Source:

Kaiser Family Foundation (2 October 2017). “The Medicare Part D Prescription Drug Benefit” [Web Blog Post]. Retrieved from address https://www.kff.org/medicare/fact-sheet/the-medicare-prescription-drug-benefit-fact-sheet/#26740


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15 Most Expensive States for Long-Term Care: 2017

Are you reaching retirement? Then, perhaps, you've already looked into the affordability of long-term care, and - well - it's not as affordable as you thought. If you're looking to get the most out of your retirement budget, then you may want to stray away from these 15 most expensive states for long-term care, as of 2017.

This article is brought to you by Think Advisor, and it was written by Marlene Y. Satter. You can read the full article here.


Genworth’s annual study on the cost of care nationwide, which includes home care, assisted living facilities, etc., is not reassuring

The price of long-term care insurance is high—for everyone involved. Not just the patient but also the caregivers pay in more than money to make sure that the person in need of care is given the best care they can manage.

In this year’s version of Genworth Financial’s annual study on the cost of care nationwide—not just in nursing homes, which are less and less on the forefront, but also care provided at home, adult day care and assisted living facilities—the news is not reassuring. Costs have risen steadily, with those for licensed homemakers—those who provide what the study calls “hands-on personal care” for patients still in their homes—rising the fastest, increasing 6.17% just since last year.

And of course since people would prefer to stay in their homes, that’s going to hit a lot of people hard.

Less-skilled “homemaker care,” such as cooking, cleaning and running errands (not included in the breakdown that follows) has risen pretty quickly as well, increasing by 4.75% since last year. But both versions of homemaker assistance are at the low end on the price scale, coming in at $21 for homemaker care and $22 for licensed homemaker care. The big bucks are elsewhere.

They may not have risen as quickly percentage-wise as the two already mentioned, but adult day care increased by 2.94% since last year to a national median rate of $70 per day. Assisted living facilities now average a median monthly rate of $3,750, an increase of 3.36% from last year, while nursing homes, at an increase of 5.50% for a private room, now run a median daily rate of $267. No matter how you look at it, that’s a lot of money.

And caregivers often sacrifice their own financial well-being to care for their family members, forking over an average of $10,000 out of their own pockets for expenses that range from household expenses, personal items, or transportation services to payment of informal caregivers or LTC facilities.

A whopping 62% are paying for these expenses out of their own retirement funds; 45% have seen those costs cut their basic quality of living; and 38% have cut the amount they devote to savings and retirement to meet the costs of care.

And another sad side effect of all this stress is that 27% say it’s had a negative impact on their relationship with the person they’re caring for.

The penalty for all this devotion is that absences, reduced hours and chronic tardiness can end up cutting a caregiver’s pay. About a half of caregivers estimate that they lost approximately a third of their income.

Check out the 15 most expensive states for LTC.

Seven Foot Knoll Lighthouse at the Inner Harbor in Baltimore.

15. Maryland

Average Annual LTC Cost: $60,305

  • Adult day care: $2,150
  • Licensed home care: $52,281
  • Assisted living: $49,800
  • Nursing home (private room): $118,990

Prospect Terrace Park in Providence.

14. Rhode Island

Average Annual LTC Cost: $60,789

  • Adult day care: $19,500
  • Licensed home care: $57,772
  • Assisted living: $61,860
  • Nursing home (private room): $104,025

Hollywood Blvd in Los Angeles.

13. California

Average Annual LTC Cost: $61,239

  • Adult day care: $20,020
  • Licensed home care: $57,200
  • Assisted living: $51,300
  • Nursing home (private room): $116,435

Seattle Sea Seahawks Fans (Photo: AP)

12. Washington

Average Annual LTC Cost: $61,704

  • Adult day care: $16,900
  • Licensed home care: $60,632
  • Assisted living: $55,920
  • Nursing home (private room): $113,362

Skier on the slopes at a Killington Resort. (Photo: AP)

11. Vermont

Average Annual LTC Cost: $63,139

  • Adult day care: $34,320
  • Licensed home care: $57,200
  • Assisted living: $49,527
  • Nursing home (private room): $111,508

State Capitol in Bismarck. (Photo: AP)

10. North Dakota

Average Annual LTC Cost: $64,010

  • Adult day care: $25,480
  • Licensed home care: $63,972
  • Assisted living: $36,219
  • Nursing home (private room): $130,367

Lobster boats in Portland.

9. Maine

Average Annual LTC Cost: $64,423

  • Adult day care: $28,080
  • Licensed home care: $53,768
  • Assisted living: $58,680
  • Nursing home (private room): $117,165

Times Square, New York City.

8. New York

Average Annual LTC Cost: $65,852

  • Adult day care: $20,800
  • Licensed home care: $54,340
  • Assisted living: $47,850
  • Nursing home (private room): $140,416

The Corbin Covered Bridge in Newport, New Hampshire. (Photo: AP)

7. New Hampshire

Average Annual LTC Cost: $66,044

  • Adult day care: $18,720
  • Licensed home care: $60,357
  • Assisted living: $58,260
  • Nursing home (private room): $126,838

Old Capitol building in Dover.

6. Delaware

Average Annual LTC Cost: $68,472

  • Adult day care: $18,850
  • Licensed home care: $50,908
  • Assisted living: $72,180
  • Nursing home (private room): $131,948

Atlantic City Beach.

5. New Jersey

Average Annual LTC Cost: $68,833

  • Adult day care: $23,400
  • Licensed home care: $52,624
  • Assisted living: $69,732
  • Nursing home (private room): $129,575

Waikiki shoreline in Honolulu.

4. Hawaii

Average Annual LTC Cost: $71,820

  • Adult day care: $18,200
  • Licensed home care: $59,488
  • Assisted living: $51,000
  • Nursing home (private room): $158,593

A statue of the Spirit of Victory in Bushnell Park in Hartford. (Photo: AP)

3. Connecticut

Average Annual LTC Cost: $72,671

  • Adult day care: $20,800
  • Licensed home care: $52,624
  • Assisted living: $55,200
  • Nursing home (private room): $162,060

Beacon Hill in Boston.

2. Massachusetts

Average Annual LTC Cost: $73,307

  • Adult day care: $16,900
  • Licensed home care: $59,488
  • Assisted living: $67,188
  • Nursing home (private room): $149,650

Crabbers on the fishing grounds in southeast Alaska. (Photo: AP)

1. Alaska

Average Annual LTC Cost: $117,800

  • Adult day care: $43,709
  • Licensed home care: $63,492
  • Assisted living: $72,000
  • Nursing home (private room): $292,000

You can read the full article here.

Source:

Satter M. (2 October 2017). "15 Most Expensive States for Long-Term Care: 2017" [Web Blog Post]. Retrieved from address http://www.thinkadvisor.com/2017/10/02/15-most-expensive-states-for-long-term-care-2017


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Apple, Fitbit to join FDA program to speed health tech

Wondering how technology can speed the process of developing health tech? In this article from BenefitsPro written by Anna Edney, gain a close insight on how Apple and Fitbit are working together with the FDA to make your health of vital importance.

You can read the original article here.


A federal agency that regulates apples wants to make regulations on Apple Inc. a little easier.

The Food and Drug Administration, which oversees new drugs, medical devices and much of the U.S. food supply, said Tuesday that it had selected nine major tech companies for a pilot program that may let them avoid some regulations that have tied up developers working on health software and products.

“We need to modernize our regulatory framework so that it matches the kind of innovation we’re being asked to evaluate,” FDA Commissioner Scott Gottlieb said in a statement.

The program is meant to let the companies get products pre-cleared rather than going through the agency’s standard application and approval process that can take months. Along with Apple, Fitbit Inc., Samsung Electronics Co., Verily Life Sciences, Johnson & Johnson and Roche Holding AG will participate.

 

A new report and video from the Health Enhancement Research Organization (HERO) identifies six promising practices for effectively integrating wearables...
The FDA program is meant to help the companies more rapidly develop new products while maintaining some government oversight of technology that may be used by patients or their doctors to prevent, diagnose and treat conditions.

Apple is studying whether its watch can detect heart abnormalities. The process it will go through to make sure it’s using sound quality metrics and other measures won’t be as costly and time-consuming as when the government clears a new pacemaker, for example. Verily, the life sciences arm of Google parent Alphabet Inc., is working with Novartis AG to develop a contact lens that could continuously monitor the body’s blood sugar.

Faster Pace

“Historically, health care has been slow to implement disruptive technology tools that have transformed other areas of commerce and daily life,” Gottlieb said in July when he announced that digital health manufacturers could apply for the pilot program.

Officially dubbed the Pre-Cert for Software Pilot, Gottlieb at the time called it “a new and pragmatic approach to digital health technology.”

The other companies included in the pilot are Pear Therapeutics Inc., Phosphorus Inc. and Tidepool.

The program is part of a broader move at the FDA, particularly since Gottlieb took over in May, to streamline regulation and get medical products to patients faster. The commissioner said last week the agency will clarify how drugmakers might use data from treatments already approved in some disease to gain approvals for more conditions. In July, he delayed oversight of electronic cigarettes while the agency decides what information it will need from makers of the products.

Rules Uncertainty

As Silicon Valley developers have pushed into health care, the industry has been at times uncertain about when it needed the FDA’s approval. In 2013, the consumer gene-testing company 23andMe Inc. was ordered by the agency to temporarily stop selling its health analysis product until it was cleared by regulators, for example.

Under the pilot, the FDA will scrutinize digital health companies’ software and will inspect their facilities to ensure they meet quality standards and can adequately track their products once they’re on the market. If they pass the agency’s audits, the companies would be pre-certified and may face a less stringent approval process or not have to go through FDA approval at all.

More than 100 companies were interested in the pilot, according to the FDA. The agency plans to hold a public workshop on the program in January to help developers not in the pilot understand the process and four months of initial findings.

You can read the original article here.

Source:

Edeny A. (27 September 2017). "Apple, Fitbit to join FDA program to speed health tech" [Web Blog Post]. Retrieved from address http://www.benefitspro.com/2017/09/27/apple-fitbit-to-join-fda-program-to-speed-health-t

 


Absent federal action, states take the lead on curbing drug costs

What's your state's stance on the cost of prescription drugs? See how Maryland has moved forward in their decision making for drug prices, giving themselves the ability to say "no" in this article from Benefits Pro written by Shefali Luthra.

You can read the original article here.


Lawmakers in Maryland are daring to legislate where their federal counterparts have not: As of Oct. 1, the state will be able to say “no” to some pharmaceutical price spikes.

A new law, which focuses on generic and off-patent drugs, empowers the state’s attorney general to step in if a drug’s price climbs 50 percent or more in a single year. The company must justify the hike. If the attorney general still finds the increase unwarranted, he or she can file suit in state court. Manufacturers face a fine of up to $10,000 for price gouging.

As Congress stalls on what voters say is a top health concern — high pharmaceutical costs — states increasingly are tackling the issue. Despite often-fierce industry opposition, a variety of bills are working their way through state governments. California, Nevada and New York are among those joining Maryland in passing legislation meant to undercut skyrocketing drug prices.

Maryland, though, is the first to penalize drugmakers for price hikes. Its law passed May 26 without the governor’s signature.

The state-level momentum raises the possibility that — as happened with hot-button issues such as gay marriage and smoke-free buildings — a patchwork of bills across the country could pave the way for more comprehensive national action. States feel the squeeze of these steep price tags in Medicaid and state employee benefit programs, and that applies pressure to find solutions.

“There is a noticeable uptick among state legislatures and state governments in terms of what kind of role states can play in addressing the cost of prescription drugs and access,” said Richard Cauchi, health program director at the National Conference of State Legislatures.

Many experts frame Maryland’s law as a test case that could help define what powers states have and what limits they face in doing battle with the pharmaceutical industry.

The generic-drug industry has already filed a lawsuit to block the law, arguing it’s unconstitutionally vague and an overreach of state powers. A district court is expected to rule soon.

The state-level actions focus on a variety of tactics:

“Transparency bills” would require pharmaceutical companies to detail a drug’s production and advertising costs when they raise prices over certain thresholds. Cost-limit measures would cap drug prices charged by drugmakers to Medicaid or other state-run programs, or limit what the state will pay for drugs. Supply-chain restrictions include regulating the roles of pharmacy benefit managers or limiting a consumer’s out-of-pocket costs.

A New York law on the books since spring allows officials to cap what its Medicaid program will pay for medications. If companies don’t sufficiently discount a drug, a state review will assess whether the price is out of step with medical value.

Maryland’s measure goes further — treating price gouging as a civil offense and taking alleged violators to court.

“It’s a really innovative approach. States are looking at how to replicate it, and how to expand on it,” said Ellen Albritton, a senior policy analyst at the left-leaning Families USA, which has consulted with states including Maryland on such policies.

Lawmakers have introduced similar legislation in states such as Massachusetts, Rhode Island, Tennessee and Montana. And in Ohio voters are weighing a ballot initiative in November that would limit what the state pays for prescription drugs in its Medicaid program and other state health plans.

Meanwhile, the California legislature passed a bill earlier in September that would require drugmakers to disclose when they are about to raise a price more than 16 percent over two years and justify the hike. It awaits Democratic Gov. Jerry Brown’s signature.

In June, Nevada lawmakers approved a law similar to California’s but limited to insulin prices. Vermont passed a transparency law in 2016 that would scrutinize up to 15 drugs for which the state spends “significant health care dollars” and prices had climbed by set amounts in recent years.

But states face a steep uphill climb in passing pricing legislation given the deep-pocketed pharmaceutical industry, which can finance strong opposition, whether through lobbying, legal action or advertising campaigns.

Last fall, voters rejected a California initiative that would have capped what the state pays for drugs — much like the Ohio measure under consideration. Industry groups spent more than $100 million to defeat it, putting it among California’s all-time most expensive ballot fights. Ohio’s measure is attracting similar heat, with drug companies outspending opponents about 5-to-1.

States also face policy challenges and limits to their statutory authority, which is why several have focused their efforts on specific parts of the drug-pricing pipeline.

Critics see these tailored initiatives as falling short or opening other loopholes. Requiring companies to report prices past a certain threshold, for example, might encourage them to consistently set prices just below that level.

Maryland’s law is noteworthy because it includes a fine for drugmakers if price increases are deemed excessive — though in the industry that $10,000 fine is likely nominal, suggested Rachel Sachs, an associate law professor at Washington University in St. Louis who researches drug regulations.

This law also doesn’t address the trickier policy question: a drug’s initial price tag, noted Rena Conti, an assistant professor in the University of Chicago who studies pharmaceutical economics.

And its focus on generics means that branded drugs, such as Mylan’s Epi-Pen or Kaleo’s overdose-reversing Evzio, wouldn’t be affected.

Yet there’s a good reason for this, noted Jeremy Greene, a professor of medicine and the history of medicine at Johns Hopkins University who is in favor of Maryland’s law.

Current interpretation of federal patent law suggests that the issues related to the development and affordability of on-patent drugs are under federal jurisdiction, outside the purview of states, he explained.

In Maryland, “the law was drafted narrowly to address specifically a problem we’ve only become aware of in recent years,” he said. That’s the high cost of older, off-patent drugs that face little market competition. “Here’s where the state of Maryland is trying to do something,” he said.

Still, a ruling against the state in the pending court case could have a chilling effect for other states, Sachs said, although it would be unlikely to quash their efforts.

“This is continuing to be a topic of discussion, and a problem for consumers,” said Sachs.

“At some point, some of these laws are going to go into effect — or the federal government is going to do something,” she added.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Source:

Luther S. (29 September 2017). "Absent federal action, states take the lead on curbing drug costs" [Web Blog Post]. Retrieved from address http://www.benefitspro.com/2017/09/29/absent-federal-action-states-take-the-lead-on-curb?page=2


Employers Broadening Health Programs

Employers are starting to change their approach on how they look at their employee benefits program. Take a look at this great article by Nick Otto from Employee Benefit Adviser and find out how employers are reclassifying their employee benefits program in order to expand their employees' well-being.

The siloed approach to retirement, healthcare and wellness is a thing of the past as employers are increasingly taking a holistic approach to addressing their employees’ health and wealth.

Employers are expanding their view of employee overall well-being, according to a new report from Optum, a technology-enabled health services company. That means that, while employers are still offering traditional wellness programs, there has been a significant shift in the last three years to those programs addressing workers’ financial, behavioral and social health.

“For example, we see increased interest among companies in developing new programs around mindfulness, positivity and creativity, which can reduce stress, improve eating and sleeping habits, and stimulate innovative thinking,” says Seth Serxner, Optum’s chief health officer.

While physical health still remains a significant focus for employee wellness programs, other dimensions are tracking with higher importance among large employers:

· 51% of such programs now address financial health, up from 38% in 2015;
· 47% address employees’ social health by using strategies like team-based activities to increase feelings of connectedness and a sense of belonging, compared to 37% in 2015; and
· 68% address behavioral health, up from 65% in 2015

And technology is helping employers to better engage these programs to workers. Since 2014, there has been a significant increase in the use of a variety of innovations, including online competitions, activity tracking devices, social networks, mobile apps and mobile messaging to help engage employees, the study notes.

Additionally, incentive strategies are helping to get workers in the wellness game.

Use of incentives is at an all-time high, Optum notes, with 95% of employer respondents offering incentives to their employees. Recognizing that workers can be highly influenced by their family members, 74% of employers also are offering incentives to family members. According to Optum, average incentives per participant per year equate to $532.

See the original article Here.

Source:

Otto N. (2017 August 15). Employers broadening health programs [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/employers-broadening-health-programs