Register for CMS’ Webinar on New Health Reimbursement Arrangements!

Three Weeks Left Until CMS' Second HRA Webinar

Don’t miss your chance to learn more about a new healthcare coverage option available to employers of all sizes: the individual coverage health reimbursement arrangement (HRA), a new way to provide your employees tax-preferred funds to pay for qualified medical expenses, including the cost of health insurance coverage purchased in the individual market. The Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) is hosting this webinar on HRAs. The webinar provides an overview of HRAs and explains the opportunities they can provide to businesses and their employees. The presentation will be followed by a Q&A session, where you will be able to ask your HRA-related questions. Click the button below to register for the webinar! We encourage you to share this email and registration link with your colleagues, business partners and other employers in your community that may be interested in learning more about the new HRA opportunities. Additionally, if you attended the first HRA webinar and still have unanswered questions or would like to listen to the presentation again, feel free to join us again on April 22.

Protect yourself from Coronavirus scams

You may already be taking steps to protect your health during the COVID-19 emergency. Be sure to also protect your identity from scammers by guarding your Medicare Number. It's easy to get distracted and let your guard down during these uncertain times. Scammers may try to steal your Medicare Number. They might lie about sending you Coronavirus vaccines, tests, masks, or other items in exchange for your Medicare Number or personal information. Protect yourself from scams: Only share your Medicare Number with your primary and specialty care doctors, participating Medicare pharmacist, hospital, health insurer, or other trusted healthcare provider. Check your Medicare claims summary forms for errors. More Info Visit Medicare.gov/fraud for more information on protecting yourself from fraud and reporting suspected fraud.

Sincerely, The Medicare Team Note: You can learn more about COVID-19 and your Medicare coverage on Medicare.gov.

Fact of the Day

Medicaid is a joint federal-state program providing health care coverage for more than 71 million low-income individuals.

Eakinomics: Making CARES Work

The United States needs to channel its inner Denmark, according to Emmanuel Saez and Gabriel Zucman – the People’s Republic of Berkeley economists who gave us the Sanders and Warren wealth taxes. (By the way, why do New Age socialists always pick Denmark, which has the population of Alabama, the gross domestic product of Tennessee, and the heterogeneity of a loaf of Wonder Bread?) Specifically, they argue that workers should be kept on the job with the government picking up, say, 80 percent of the costs and the guarantee of returning to their jobs. (This is the main course; there is an appetizer of CovidCare for All – a precursor to single-payer – and a dessert of excess profits taxes.)

Specifically, “The next congressional bill needs measures to protect employment for the duration of the shutdown,” and “several nations with no experience in that area – like Britain, Ireland, and Denmark – were able to introduce brand-new employment guarantee programs on the fly during the epidemic.”

There are (at least) two problems with that argument. First, by the time the next bill is law, large swaths of the economy will lie in ruins. This is a classic example of academics who would rather be right than useful. Second, the Coronavirus Aid, Relief, and Economic Security (CARES) Act largely takes care of the underlying employment challenge. The challenge is to make it work.

To begin, CARES provides aid to the airlines equal to their average payroll that can only be spent on employment costs and that carries the requirement that there be no layoffs. That is, the government will pay 100 percent of the payroll costs for the peak of the pandemic. CARES contains a $350 billion Paycheck Protection Program that consists of loans to small businesses to cover their payroll costs. If employers do not lay anyone off (and they must rehire those they recently let go), the loan is forgiven. That is, the government will pay 100 percent of the payroll costs for the peak of the pandemic. Starting to sound familiar? (It is true that the loans to larger businesses do not require maintaining payroll, but that would be the main use of those monies in any event.)

There are other virtues of the design of the CARES loan program, such as the voluntary participation, but the main issue is making the program work. Specifically, AAF’s Dan Bosch, Dan Goldbeck, and Thomas Wade highlight the extraordinary demands being placed on the Small Business Administration: “The SBA’s capacity presents a major potential implementation challenge. Across its lending platforms, SBA approved $28.2 billion in loans in FY 2019 – 8 percent of what it is being asked to distribute in short order. In order to overcome these challenges, the process will have to be streamlined to an extraordinary degree. In addition, the agency’s budget request for 2020 was $820 million, of which less than half would support direct lending assistance. $349 billion effectively equals roughly one thousand times the usual annual guaranty amount, delivered in only two months.” Somebody better call in the cavalry!

The point should not be to change the strategy; the goal should be to make it work. 

On the Record

"To the extent possible, you've got to rely a lot on your own network staff, the decisions they can make. You still have to rely on the vendors in certain places, but they may not always be there given they're going to be stretched a thousand different ways."

— Mike Vennera, senior vice president and chief information officer of Independence Blue Cross, talked with AIS's Health Plan Weekly about the challenges involved in shifting an insurer's employees to telework amid the COVID-19 pandemic.

Subscribers may read the Health Plan Weekly article in which this quote appeared online. Learn more about subscribing to AIS Health's publications.

The FDA last week approved...

...Roche's phase 3 trial of its interleukin-6 inhibitor, Actemra, in COVID-19 patients that have been hospitalized with pneumonia. The drug was already used to treat coronavirus patients in China. The drugmaker also said it has added 10,000 vials of Actemra to the Strategic National Stockpile. The intravenous form of Actemra is covered under the pharmacy benefit for 25% of insured lives, and under the medical benefit for 21% of lives. 37% of all covered lives have access to Actemra under both the pharmacy and medical benefit.

SOURCE: MMIT Analytics, as of 3/30/20

Private Payers Aren’t Yet Sold on Vraylar for Bipolar Disorder

by Bronwyn Mixter

TA recently approved brand drug for bipolar disorder will have little impact on how health plans cover these medications, experts say. Health plans will continue to encourage the use of less expensive generic bipolar drugs.

The brand drug, Allergan plc's Vraylar (cariprazine), was approved by the FDA to treat depressive episodes associated with bipolar 1 disorder in adults. It is an oral, once-daily atypical antipsychotic.

There are other medications approved to treat the same conditions as Vraylar, including generic drugs, Mesfin Tegenu, R.Ph., president of PerformRx, tells AIS Health. Vraylar is typically not a preferred option since it is a newer, branded and more expensive agent, and more cost-effective alternatives are available, he says.

However, non-formulary drugs are available to those who have a demonstrated medical need. "There can be adherence issues with this disease and at times there is a need for longer acting agents to improve adherence," Tegenu says.

Health plans employ several utilization management techniques for bipolar drugs, according to Tegenu. Some examples include prior authorization, duplicate therapy edits, age restrictions and step therapy.

For Vraylar, health plans will use prior authorization or steps to encourage the use of a generic bipolar drug first, Michael Schneider, a principal at Avalere Health, tells AIS Health. There also could be some higher out-of-pocket costs for Vraylar even when compared to some of the other branded antipsychotic drugs.

Vraylar is in a protected drug class on the Medicare side, Schneider says. Because it is the first brand drug of a particular chemical entity, plans have to cover it. In some Medicare plans, Vraylar is disadvantaged because even through it is in a protected class, there are still utilization management techniques placed on the product, as well as higher cost sharing, he says.

In Medicaid, many states require all the antipsychotic bipolar drugs to be on the formulary with no utilization management, Schneider adds.

From RADAR on Drug Benefits