Specialty Drugs & the Rising Cost of Healthcare

The cost of insurance is on the rise at an alarming rate.  In 2017, the average person in the United States spent $10,739 per individual in the household annually, versus just $146 in the year 1960.  In fact, health care costs have risen at a faster pace than the average annual income in the U.S.  Why is this? 

Some believe that you can blame specialty drug costs. Spending for prescription medication has risen each year and the high prices of new novelty drugs, such as new therapy drugs that require special handling or monitoring, are a major contributing factor to rising premiums.  According to current Medicare figures, these specialty pharmaceuticals will often cost a patient upwards of $600 per month.

These specialty drugs are generally aimed at areas of medicine that haven’t yet found reliable cures--chronic or complex conditions such as cancer, Hepatitis C, Multiple Sclerosis, Parkinson’s Disease, HIV or Rheumatoid Arthritis. In California in 2017, over half of the prescription drug spend was on specialty drugs.

Demand and prices for these drugs are skyrocketing. Drug companies say they have no choice but to charge more to recoup their high research and development costs. If they can’t do that, they have warned: these drugs won’t make it to market.

As a result of this, insurers have been hard pressed to provide access to these drugs without significantly raising their plan rates to cover the high costs. For instance, a generic drug may require just a $10 copay, while some specialty drugs require a patient to pony-up as much as 33% of the cost, often resulting in thousands of dollars in patient expenses each month.

Medicare and Medicaid are forbidden by law to negotiate prices, so they must leave it up to the insurance companies to decide which drugs they can offer under their plans. But these new costs are now being passed on to the patient/consumer in the form of higher premiums. New medical break-throughs can save lives, and we must support such innovation and access. But can we afford it?

According to Harvard Medical School, some pharmaceutical companies do charge more for these drugs claiming market exclusivity, and the U.S. Senate Special Committee on Aging has been researching this problem. How much is a drug really worth? The average annual retail cost of some of these drugs exceeds the median U.S. household annual income, and is more than three times the average Social Security benefit.  And it’s not about to stop now.  Spending on specialty drugs, according to some, is expected to more than quadruple by the year 2020.  While there are always new medications being produced, those on a fixed income may not be able to afford them, and this is a growing burden on the health care system.

Insurers such as Cigna, Aetna, Anthem and Kaiser Permanente report that in 2017, they spent up to $600 million for specialty drugs as opposed to $270 million on brand-names and just $170 million on generics.

Reducing these costs is important and The National Coalition on Health Care (NCHC, made up of more than 80 medical societies), warns of “…a tsunami of expensive medicines that could literally bankrupt the health care system.”  To combat this, the NCHC have launched a campaign for sustainable Rx pricing. Also, research by Pew Charitable Trust has begun identifying and evaluating options of controlling overall pharmaceutical spending while still ensuring patient access to important medications.

Can these efforts work? We must patiently wait and see. But opinions are positive, with so many firms, individuals and the federal government now seeking answers.

Questions?  We are here.

Oral Hygiene Plays Crucial Part in Surgical Patient Hospital Care

Dental care and general medical care have been approached as two separate professions since 1840.  The story goes that two self-trained dentists were turned away from a medical school in Pennsylvania where they had proposed offering an oral care specialty program, subsequently opening their own dental school, and the rest is history.  Today, dental care is not only a completely separate profession but requires separate insurance and a separate set of patient records.  And studies have found that separating dental care and dental hygiene from the rest of your physical wellness can sometimes have dire consequences, especially among post-surgical patients. 

New California Law Says Goodbye to Bathroom Breast Pumping

Most people are understandably horrified at the thought of anyone eating in a bathroom.  But providing more appropriate spaces for lactating mothers who need to pump? This has proven tricky…until now.  California lawmakers are stepping up their efforts to mandate safe and secure locations for nursing mothers to pump, and in 2019 we are facing stronger laws surrounding workplace lactation rooms so that nursing mothers can juggle the task of pumping with dignity.

Until recently, California state laws have required employers to provide a reasonable place to pump, with the law stating that this space should be somewhere “other than a toilet stall.”  While it was specified that a toilet stall would not suffice, many employers interpreted this to mean that designating other areas of the bathroom would keep them in compliance. No more. 

California Senate Announces New Sexual Harassment Prevention Training Laws

Since 2005, California law has required that companies with 50 or more employees provide sexual harassment training for personnel in supervisory positions.  Recently, a new law was announced expanding these requirements to smaller businesses and more staff members.

By January 1, 2020, businesses in California with at least five employees must provide sexual harassment prevention training and education to all personnel in supervisory and non-supervisory positions, according to California Senate Bill 1343. 

Nurse Practitioners & Physician Assistants Pick Up The Slack

Recent findings from the Health Care Cost Institute reveal what many patients have already learned - when you visit the doctor, you won’t always be seen by an actual physician.  Increasingly, patients who visit their primary care doctor, particularly for last minute care, will be seen by a nurse practitioner (NP) or a physician’s assistant (PA).  In fact, the study revealed that between 2012 and 2016, the number of patients who received their primary care from an NP or PA instead of their regular doctor had increased by 129%.  In 2012, 51% of patients were seen by a doctor and in 2016 that percentage dropped to just 43%.  Interestingly, patient visits to primary care offices as opposed to specialists have simultaneously decreased by 18%. 

While some of this is attributed to an aging population, there’s also an increasing shortage of physicians, as many new practitioners are opting to go into specialties as opposed to general medical practice.

Wellness Questionnaires for Employee Insurance Discounts? No more. Let’s explore…

Effective January 1, 2019, insurance discounts to employees who fill out health questionnaires and take health evaluation tests will no longer be valid, according to the Equal Employment Opportunity Commission.  These rules allowed employers to grant up to a 30% discount to those employees who voluntarily filled out wellness forms or participated in fitness exams, in an effort to encourage healthy living. 

In July 2016, new rules were issued by the EEOC under the Americans with Disabilities Act (ADA) and the Genetic Information Non-discrimination Act (GINA) with regard to these plans, saying that employers could implement penalties or issue discount incentives of up to 30% on self-only coverage to encourage staff members to “voluntarily” disclose information otherwise protected by the ADA.

Genomic Medicine: To cover or not to cover? Top questions you should be asking

The world of genomic medicine and genetic testing is wildly building momentum.  With tests to determine reproductive issues, prenatal testing, and hereditary cancers, the theory of being able to predict the probabilities and risks before the onset of symptoms is very appealing.  The marketplace currently boasts over 75,000 such genetic tests currently available.  But with new tests emerging into the marketplace daily (some estimate 10 new tests per day) there are a lot of questions surrounding whether they should be covered. And with things happening so quickly, the science has been inconsistent in many of these tests, with reports of false positives.  With such a rapidly increasing marketplace, it’s difficult for employers to know which tests are beneficial to their employees and what should be covered.

Holiday Cranberry Raspberry Sauce

It's that time of year again, when celebration foods come out to play.  Did you know that 20% of the world's cranberries are consumed on Thanksgiving Day? 

While fresh cranberries may be harder to find during the rest of the year, they are an excellent source of anti-oxidants, have been known to prevent gum disease, boost your immune system and help reduce bad cholesterol. 

Wearable Wellness With Cost Benefits

Holiday shopping is right around the corner, and at the top of many people’s list is a wearable device.  Smart watch and wearable device technology have taken a big step forward in the world of health and quality of life management in recent months. Some insurers and health care professionals are weighing in on what’s being called “Mobile Health Management.”

During Apple’s keynote address in September, where all the technology giant’s latest product upgrades debut each year, it was announced that the new version of the Apple Watch now offers, among other things, heart monitoring. This new EKG element allows you to track your biometrics as you go through your day to help you manage and monitor your health while motivating you to walk, swim, work and rest; and the insurance industry is all ears.

Holiday Party Risk Management Tips for Employers

The holidays are here!  Parties are starting to populate our calendars, shopping lists are being developed, and perhaps you’ve already started to plan out your company’s holiday gathering.  Way to be on the ball!

Company parties often come with concerns about overindulgence in alcohol, which can pose threats legally and socially among team members.  When planning your company holiday party, you want to be sure to minimize these risks, and alcohol consumption on the company’s dime can be a cause for concern.  Everyone loves to celebrate, and company outings and parties are important for team bonding.  So, what are some best practices when it comes to your employees and holiday parties where alcohol is served?  Here are our top tips…

Big News for Consumers: Your Pharmacist May Now Tell You if You Can Get a Prescription Drug at a Lower Cost

Were you aware that until recent legislation was passed this month, pharmacists were prevented from telling consumers they could purchase their prescription for a lesser cost than their applicable copayment under their insurance plan? This ‘gag’ order prevented pharmacists from revealing to patients that a lower cost purchase option was available. This was permissible due to provisions in their contracts with the influential companies that manage drug benefits for insurers and employers. The clauses forced the pharmacists to remain silent as, for example, a consumer pays $100 under his insurance plan for a drug that would have cost $75 if purchased with cash.

Recipe of the Month: Crunchy Roasted Chickpeas

Recipe of the Month:  Crunchy Roasted Chickpeas

Chickpeas, AKA garbanzo beans, are nutty in flavor, packed with plant protein, low in calories and fat and have endless uses whether blended into a hummus or a soup, or thrown into a salad for extra protein and flavor.  Toss some canned chickpeas in these smoky red spices and enjoy a crunchy, protein-filled snack. 

Here’s how to make it… 

2019 Affordable Care Act Percentage

2019 Affordable Care Act Percentage

More updates coming to the ACA!  The IRS is making changes to the Affordable Care Act’s affordability percentage in 2019. 

What does that mean to you as an employer? The affordability percentage determines if an employer’s offering of health care coverage for its employees and their dependents is affordable based upon a certain percentage of salary.  Let’s explore.

Pros & Cons of Workplace Wellness Programs

Pros & Cons of Workplace Wellness Programs

How much is too much when it comes to your health and privacy? 

That’s the big question up for debate right now, and at the center of it all are workplace wellness programs.  On paper, these programs seem like a no brainer for both employers and their employees – an opportunity to keep health costs down while encouraging a healthy lifestyle.  What’s not to like?  But what about those employees who don’t, or simply can’t, participate?  There is cause for concern when it comes to alienating employees who don’t, or can’t, participate in them, while others have raised concerns that they can sometimes border on an invasion of privacy.  So, as employers, where do we draw the line?

Let’s explore some of the pros and cons of workplace wellness programs:

House of Representatives to Debate ACA Employer Mandate Bill Next Week

Since the Affordable Care Act passed in 2010, there has been much debate as to its details. The ACA was signed into law on March 23, 2010, and since that time, there have been over 70 changes to the law, making it look quite different than what was passed eight years ago.

Once again, more possible changes are looming for the Affordable Care Act, as members of the U.S. House of Representatives on Thursday voted 222-171 to bring an Affordable Care Act employer mandate revision bill for a vote by the full House next week.

House Resolution 1059, as it is known, sets the rules of debate for what they are calling the “Save American Workers Act of 2017″ bill, which would specifically tweak the ACA employer mandate bill.

How would it affect your workplace?  Read on…

"Fur"ternity or "Paw" ternity Leave: Exploring New Pet-Friendly Benefits

"Fur"ternity or "Paw" ternity  Leave:  Exploring New Pet-Friendly Benefits

If you’ve ever adopted a new pet, you understand the stress and patience needed during the early days when you’re still getting to know each other.  And if you’ve adopted a puppy, you may very well feel like you just had a baby. Late-night bathroom emergencies and ruined furniture is part of the experience, but all is forgiven. How could you stay mad when those two big brown eyes look at you in a way that makes you feel like only your dog understands you? 

With reasons beyond just the condition of your furniture, more and more companies are adopting pet-friendly policies, with many of them now allowing dogs in the workplace. 

Back to School & The Family School Partnership Act

Back to School & The Family School Partnership Act

t’s nearly fall, students are returning to school, and families are getting back into their normal routines after a less structured and often more-relaxed summer break. 

While many working parents welcome the change of pace and ability to renew their focus on work while the kids are in school, they may also feel pulled between calls to participate in school-related activities and concerns with missing time at the office. Finding balance between our personal and professional lives is essential to the strength and success of a workforce.  Creating an environment that encourages work-life balance has been shown to increase employee loyalty and drive to succeed; an important component to the success of any company. And, in some states, it may also be the law…

Nominations Now Open for the 2019 NPA Garnett-Powers & Assoc. Mentor Award

Nominations Now Open for the 2019 NPA Garnett-Powers & Assoc. Mentor Award

We are thrilled to announce that nominations are now open for the 2019 NPA Garnett-Powers & Associates, Inc. Mentor Award.  In our partnership with the National Postdoctoral Association (NPA), this award recognizes a faculty member or advisor who has engaged in exceptional mentoring of postdoctoral scholars in their professionalism, accessibility, communications, support, advocation, guidance and networking, in creating a productive and inspiring working environment to enhance and elevate the postdoctoral experience.

News on Legal Postings for California

News on Legal Postings for California

California has updated the EDD Notice to Employees, Discrimination posting requirements, Transgender Rights in the Workplace, as well as the Unemployment Insurance Notice. Consequently, if you haven’t already done so, contact the poster company you use to provide you with the appropriate compliance poster(s).