Employer-Sponsored Insurance & Specialty Pharmacy

Hosts Ron Bachman and Doug Field are live in the studio with special guests from CBIZ and Minnesota Health Action Group for a discussion on specialty pharmacy, medical insurance and more. But first, Ron and Doug delve into what attendees can expect at the upcoming Private Exchange FORUM in Baltimore. 

The first guest on the show this week is Carolyn Pare, president and CEO of the Minnesota Health Action Group. Costs for specialty medications to treat life threatening diseases, and even some common conditions like high cholesterol, are projected to quadruple by 2020. Right now, employers who buy health care coverage for their employees are on the hook for those costs. But with treatment price tags like $100,000 per year, per patient, the breaking point may be near. There’s a real likelihood that specialty drug pricing could financially overwhelm employers. In this interview, Carolyn Pare tells you more about the issue, why it matters and what employers can and should do.

The second guest on this week's program is Joe Ellis, SVP of CBIZ Benefits & Insurance Services. In this segment, Joe discusses what employers and employees need to be aware of when examining in-network participation. PPOs have dominated the health care and health insurance landscape since the HMO Act was enacted in 1973. Joe explains how PPOs have driven employees to consistently seek out in-network care, thereby reducing the value of “preferred” status and, ultimately, cost controls promised to employers using PPOs. Also, the quality of care needs to be addressed which is not directly done in a traditional PPO. He identifies three trends in the health insurance industry that will move the needle in this space: networks will be shrinking, the use of reference-based pricing and the role of Accountable Care Organizations.