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Pharmacy Benefit Management – Part 3 – Case Study

How can your company reduce pharmacy costs while providing the best care and service to employees? Our PBM model consistently delivers high value and significant savings to clients. While each element of our program produces savings for clients, the savings are maximized when all programs are implemented. As each pathway targets different savings opportunities. In […]

Pharmacy Benefit Management – Part 2

Do you know how specialty medications are impacting your company’s health insurance costs? While specialty medications offer promising treatment options for complex conditions, their high cost can pose challenges for affordability and access, impacting both patients and healthcare systems. Specialties not only cause significant increases to the overall plan, but can impose financial hardships on […]

Pharmacy Benefit Management – Part 1

When medication costs go up, insurance costs follow suit because insurance companies have to cover those expenses. So, rising pharmaceutical medication prices can lead to higher health insurance premiums for consumers. If you are self-funded and using a Pharmacy Benefit Manager you need to understand how your PBM is managing the cost of pharmaceuticals. Employee […]

IRS Guidelines – Indexed for 2024

FICA Social Security Tax is 6.2% on income up to $168,600 Medicare Tax unlimited 1.45% to Unlimited ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 8.39% of an employee’s household income for the 2024 plan year. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,600 / $3,200 […]

Florida PBM Reform is Here

Effective July 1, 2023 the Florida legislation reshapes the PBM landscape, requiring that PBMs pass through 100% of all manufacturer rebates to plan sponsors, while prohibiting spread pricing, clawbacks, mail order mandates, affiliate-only networks, and other practices that have long been status quo for many in the pharmacy industry. Florida SB 1550 requires that entities […]

CAA 2023 Allows for Telehealth Relief

The Consolidated Appropriations Act, 2023 (CAA23) was signed into law on December 23, 2022. One of the health provisions contained in the law was the relief on telehealth coverage offered through HSA Qualified High Deductible Health Plans (HDHPs). Typically, HSA-qualified HDHPs cannot pay for covered services, except for specified preventive care, until the individual satisfies […]

IRS Guidelines – Indexed for 2023

FICA Social Security Tax is 6.2% on income up to $160,200 Medicare Tax unlimited 1.45% to Unlimited Individual Mandate’s Affordability Exemption — required contribution percentage is 8.17%. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,500 / $3,000 Maximum Out-of-Pocket Limit (Individual/Family) $7,500 / $15,000 Health Savings Accounts Individual / Family $3,850 / $7,750 Catch-up Contribution […]

Significant Change in ACA Affordability

The Affordable Care Act (ACA) benchmark for determining the affordability of employer-sponsored health coverage will significantly decrease to 9.12% of an employee’s household income for the 2023 plan year. This is a significant decrease from the 2022 level of 9.61%. This affordability percentage affects an individual’s eligibility for federally subsidized coverage from a marketplace exchange. It also […]

Fat People Are Costing Your Company

Several years ago, I blogged, Fat People Have Issues, with the disclaimer of posting the politically incorrect title in hopes of getting more people to read. Not being one to suddenly bow to the woke politically crowd I have posted another potentially insensitive title, again, in hopes of getting more people to read. As I […]

Overpaying for Prescriptions? – Try this

If you are fortunate enough to have health insurance with a low deductible or low-cost prescription co-pays, the high cost of drugs is driving up the premiums that you or your employer pay, making getting health insurance expensive and challenging. Every American should have access to safe, affordable medicines. If you don’t have insurance or […]

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