TransparentRx’s Post

The Inflation Reduction Act introduces significant changes for employer-sponsored health plans, particularly in prescription drug pricing and Medicare negotiations. Employers must proactively assess these developments to ensure compliance and optimize benefits for their workforce. 🔎 Key considerations include: → Prescription Drug Pricing: The Act aims to lower drug costs, potentially affecting plan formularies and cost-sharing structures. → Medicare Negotiations: Enhanced negotiation powers may influence drug pricing dynamics, impacting employer plan strategies. → Out-of-Pocket Caps: New limits on out-of-pocket expenses could alter plan designs and financial planning. Staying informed and adaptable is crucial for employers to navigate these changes effectively. #HealthCareReform #EmployerBenefits #PrescriptionDrugPricing #InflationReductionAct #EmployeeWellbeing Read more about the Act's implications for employer-sponsored health plans. 👇

The Inflation Reduction Act introduces significant changes for employer-sponsored health plans, particularly in prescription drug pricing and Medicare negotiations. Employers must proactively assess these developments to ensure compliance and optimize benefits for their workforce. 🔎 Key considerations include: → Prescription Drug Pricing: The Act aims to lower drug costs, potentially affecting plan formularies and cost-sharing structures. → Medicare Negotiations: Enhanced negotiation powers may influence drug pricing dynamics, impacting employer plan strategies. → Out-of-Pocket Caps: New limits on out-of-pocket expenses could alter plan designs and financial planning. Staying informed and adaptable is crucial for employers to navigate these changes effectively. #HealthCareReform #EmployerBenefits #PrescriptionDrugPricing #InflationReductionAct #EmployeeWellbeing Read more about the Act's implications for employer-sponsored health plans. 👇

The Inflation Reduction Act introduces significant changes for employer-sponsored health plans, particularly in prescription drug pricing and Medicare negotiations. Employers must proactively assess these developments to ensure compliance and optimize benefits for their workforce. 🔎 Key considerations include: → Prescription Drug Pricing: The Act aims to lower drug costs, potentially affecting plan formularies and cost-sharing structures. → Medicare Negotiations: Enhanced negotiation powers may influence drug pricing dynamics, impacting employer plan strategies. → Out-of-Pocket Caps: New limits on out-of-pocket expenses could alter plan designs and financial planning. Staying informed and adaptable is crucial for employers to navigate these changes effectively. #HealthCareReform #EmployerBenefits #PrescriptionDrugPricing #InflationReductionAct #EmployeeWellbeing Read more about the Act's implications for employer-sponsored health plans. 👇

After the Inflation Reduction Act, how can Medicare still call employer health plans creditable drug coverage? In spite of the changes to Medicare Part D in 2025 due to the Inflation Reduction Act, Medicare is still calling almost all employer health plans creditable even though their drug benefits can’t match Medicare Part D in many, if not most, cases. How are they doing this? CMS is allowing employers to use the old Simplified Determination Methodology without updating it to match the 2025 realities. The Simplified Determination Methodology only requires employer health plans to answer three questions: 1. Is the deductible for medications lower than $590? 2. Does the plan cover generic and brand-name medications? 3. On an actuarial basis, does the health plan cover at least 60% of the cost of prescriptions? This appears to be a move to prevent political fallout, but it doesn’t appear to be in line with the law which states that you must have drug coverage that is equal to Medicare or face penalties. As an advocate for seniors, I’m happy that the many seniors who need an employer plan because they are covering their dependents will be protected. As a citizen who believes in the rule of law, I’m frustrated that CMS can circumvent the law to protect people in power from the reality of their policies. #CMS #CreditableCoverage #EmployerHealthPlan #Medicare #PartD

Nearly 25% of every dollar Americans spend on health care premiums goes to prescription drug costs, while over 40 cents covers hospital expenses. As health care costs continue to rise, Oklahoma health plans are committed to delivering access to high-quality care as affordably as possible. 👉 Dive deeper: https://lnkd.in/g4KKqpqK AHIP #HealthInsurance #PatientCare

We’ve been getting a lot of questions in our public sector practice about all the changes to in the Inflation Reduction Act and the impact on MAPD. Well… Big changes are coming to Medicare Part D (the prescription drug piece of Medicare) in 2025 that will impact employer group health plans, and we’re here to help break it down. Check out our on-demand webinar where HUB experts review changes to the Medicare Part D rules, and what these changes mean for employers, their employees and their compliance obligations. https://ow.ly/7eEr50TtVbc #EmployeeBenefits

As we look ahead to 2025, the landscape of healthcare is shifting dramatically, particularly with the inflation of medical renewals driven by the increasing prevalence of prescription and weight loss drugs. This trend presents both challenges and opportunities for professionals in the healthcare and insurance sectors. With innovative treatments becoming more accessible, we're witnessing a surge in demand for medications that can significantly improve patients' quality of life. However, this also raises questions about the sustainability of healthcare costs and the implications for insurance premiums employers are having to pay. It's crucial to engage in strategic conversations around cost management, patient access, and policy adjustments that can help mitigate these rising costs. Collaboration among stakeholders—providers, insurers, and policymakers—will be key to finding balanced solutions that prioritize patient care while maintaining financial viability. Reach out to see what Holmes Murphy is doing about these rising costs! #HealthcareInflation #SpecialtyRx https://lnkd.in/gTMVGwQM

🚨Attention Employers: Important Medicare Part D Update for 2025!🚨 With the changes brought by the Inflation Reduction Act of 2022, it's crucial to review your group health plan's prescription drug coverage. 📅 What's New? * New Part D Benefit Design: Includes deductible, initial coverage, and catastrophic coverage. * Lower Out-of-Pocket Threshold: Now $2,000. * Coverage Gap Changes: Transition from Coverage Gap Discount Program to Manufacturer Discount Program. 🚨 Why It Matters: Some employer-sponsored plans, especially high-deductible health plans (HDHPs), might not be considered "creditable" starting in 2025. This means they may not be as good as Medicare Part D. 🛠️ Action Required: 1. Review Your Plans: Determine if your coverage is creditable or non-creditable for 2025. 2. Notify Participants: Inform Medicare Part D-eligible individuals about their coverage status. 3. Notify CMS: Update CMS about the creditable status within required deadlines. For more information, visit cms.gov Stay proactive to ensure compliance and avoid potential issues for your employees. #inpirebenefitconsultants #healthInsurance #medicarepartd #employeebenefits #inflationreductionact #compliance #healthcareupdates #broker #consultants

Once upon a time we didn't have PBMs, TPAs or Stop-Loss coverage. Once upon a time we didn't self-fund health plans, have options to level-fund or even have consultants to analyze your pharmacy benefits and contracts. As markets became more complex, so too did the solutions to keep up with the ongoing changes in health plan administration. It reminds me of where TV subscriptions are now. We used to have rabbit ears for local channels or pay for cable. Now you can completely customize your media experience; subscribe to a platform individually or purchase a bundled package from someone else to "save money." If you're a broker or benefits consultant, now more than ever do you have the power to pair your clients with vendors that meet their plan's exact needs. If prescription drug spend is a concern (let's be honest, even if it's not #1, it's up there), a solution that works ahead of your PBM and clinically influences prescribing decisions might sound pretty appealing. We're here, Apothicor Wellness #apothicorwellness #healthcare #wellness #healthbenefits #benefits #employeebenefits #drugs #pbm #pharmacists

Wondering if your #Pharmacy Benefit Manager is truly benefiting your employer health plan? With many Americans feeling PBMs overcharge, it's vital to evaluate their transparency and efficiency to control the rising prescription drug costs for your employees. Learn more 🔗 https://lnkd.in/eyB-4biv #TheBaldwinGroup #ProtectingThePossible #EmployeeBenefits