HBCH and the Center for Houston’s Future co-hosted a forum last week at Rice University, Health Equity: A New & Necessary Frontier in Employee Benefits. Employers and other Houston community leaders discussed opportunities to address Houston’s health inequities. HBCH and CHF are partnering to bring employers to collectively impact disparities and inequities in communities in which their employees live and work. Contact Megan Rose at CHF for more information, mrose@futurehouston.org.
St. Luke’s Health in partnership with Houston Public Media, explores the challenges and opportunities to address Houston’s health inequities through a 10-part ExamiNATION video series. Each summary video is worth the watch!
Employer Attestation of Gag Clause Removal
The Consolidated Appropriations Act, 2021 (CAA), requires group health plans and insurers to attest by December 31, 2023 that they are in compliance with the gag clause prohibition under the CAA. Click here to learn more and see a list of the Top 10 Gag Clauses. Perhaps most important, employers can no longer be denied access to their claims data. This prohibition is also codified at the Texas state level with the passage of House Bill 711 during this year’s legislative session. Claims data access will allow employers to design strategies that reward employees choosing value and providers for offering value.
A PBM Playbook for Benefits Managers
The National Alliance of Healthcare Purchaser Coalitions of which HBCH is a member represents more the 50 million employer-sponsored lives. It recently released a Play-book for Employers to address PBM misalignment. This is a document that employers will want to discuss with their benefits consultants. This playbook was developed as a catalyst for change and, equally important, a blueprint to help foster positive, constructive steps to create better PBM alignment. Below is a list of Top 10 Pharmacy Benefit Management Concerns. The Playbook provides action steps to achieve value.
Promotion of higher-price drugs when lower-price drugs are available.
Coverage of a brand when a generic or biosimilar is available.
Coverage of specialty drugs not supported by evidence.
Automated prior authorization causing rates to soar over 90%.
Redefining generics as brand drugs or vice-versa to manipulate guarantees.
Systematic waste including refilling too soon, automatic 90-day refill.
Coverage of high-cost, low-value drugs.
Replacing drugs eligible for 340B rebates with drugs not eligible.
Narrow definition of “rebates” which allow PBM to pocket Rx revenue.
The 2023 HBCH Mental Health program will provide benefits leaders with new tools, information, and action steps to improve your mental health strategy. Employers, Benefits Consultants, Health Plans, Health Systems, Physicians, and Subject Matter Experts will provide insight on what is, but more important what can be.
