Dickerson - February 27, 2025

Anthem is required to include the average monthly premiums paid by members and by employers in the Premium and Life Years (D1) reporting. The next RxDC report is due by June 1, 2025 . Anthem will follow the same process as in prior years and will file on behalf of fully insured and ASO clients for the benefits they administer and maintain. This includes ASO groups who opt-in to the D1 reporting. The Prescription Drug Data Collection (RxDC) reporting provision of the Consolidated Appropriations Act (CAA) requires reports on drug utilization and spending trends be submitted to the U.S. Department of Health and Human Services each year. Here is a summary of the communications Anthem will send to Large Group, Small Group, and National Account clients and the actions they will need to take for Anthem to complete their required RxDC filing. The week of February 17 – Fully Insured clients • Email Fully Insured National Account, Large Group, and Small Group commercial clients, as well as clients with Minimum Premium, MEWA, and Anthem Balanced Funding plans. The email will include a link to an online form for these clients to provide the information Anthem needs to complete the filings on their behalf. Also the week of February 17 – ASO client D1 opt-in • Email ASO Large Group and National Account clients and provide a link for them to request that Anthem file their 2024 D1 Premium and Life Years report. For those who opt-in, Anthem will submit the aggregated data by market segment on their behalf for the benefits Anthem administer and maintain. Early June 2025 -- Confirmation of RxDC filing • When the filing is complete, Anthem we’ll publish an article in Employer Access Latest News to let clients know. Anthem we’ll also post an article in our Broker Hub, Broker Plus app, Producer Toolbox, and Anthem Consultant Hub new channels. For More Information on RxDC Reporting, Please Contact Your Dickerson Sales Rep.

Health Net, as part of the No Surprises Act (NSA) under the Consolidated Appropriations Act, 2021 (CAA), is required to submit prescription drug and health care spending data to the: Department of Labor, Health and Human Services, Treasury and the Office of Personnel Management. Health Net will meet all regulatory obligations for 2024 reporting due June 1, 2025 . This prescription drug data submission, known as the RxDC report, is gathered by the Centers for Medicare and Medicaid Services (CMS). Key reporting details • The RxDC report is due each year – beginning December 27, 2022 (for reference years 2020 and 2021) – and by June 1 of each subsequent year. • The 2024 RxDC report is due by June 1, 2025. Note: This is for your information only – no action is required. What Health Net of California, Inc. (Health Net) is Doing • Health Net successfully filed the 2023 RxDC report on behalf of employer groups before June 1, 2024. • Health Net will meet all regulatory obligations for 2024 reporting due June 1, 2025. • The Plan will not require any data from employer groups to complete Plan List (P2) and Data File (D1) submissions on behalf of clients. • The Plan will not issue communications to members, groups regarding RxDC filing (confirmation of filing completion, compliance, etc.), as this is not a regulatory requirement. • The Plan will not establish contracts with groups regarding RxDC reporting, as this is not required by regulations. • Employer groups do not need to take any action or pay any fees to Health Net for this reporting. More information – FAQ • What will be submitted? o D1 – D8 files will be submitted. • At the time of submitting D2, is the aggregate total reported under Health Net’s EIN o Yes. • If D2 is submitted as an aggregate, are the rest of the submissions also aggregated? o Yes. • Will Health Net submit a Narrative Response? o Yes. For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep .

When an employer experiences financial hardship, the situation can raise concerns regarding its employee benefit programs. Employers can experience financial strain for any number of reasons — low sales and revenue, increased overhead costs, natural disasters, reduced funding, a pandemic or financial mismanagement. In such a situation, an employer typically has questions regarding its employee benefits plan and the costs associated with its offerings. Following are considerations for employers when addressing one of these difficult financial situations. Plan documents and termination vs. furlough vs. layoff Some employers will have to respond to an economic downturn by terminating employees, implementing layoffs or furloughing employees. It’s important to remember that “termination,” “furlough” and “layoff” are not defined terms under ERISA or the Affordable Care Act. A furlough is considered to be a mandatory leave with limited or no pay, with the expectation that employees will return to work once regular business resumes. A termination and a layoff are more similar, but an employee who is temporarily laid off will be asked to return to work. The problem from an employee benefits perspective is that plan documents do not usually differentiate between an employee who is terminated vs. one who is laid off vs. one who is furloughed. For benefits purposes, eligibility is limited to active full-time employees and employees who work at least a minimum number of hours per week (e.g., 30). If an employee is on protected leave — such as those granted under the FMLA — benefits continue during leave. This means that any employee who is not meeting the hours requirement or is not actively at work (work from home is considered actively at work) based on being terminated, furloughed or laid off — even temporarily — will generally have their benefits terminated and receive an offering of COBRA or state continuation, or have no offer of continuation, depending on the employer’s size and state in which the business is located. It’s important to review the plan documents from the carrier to determine whether leave is paid or unpaid and to determine how long benefits may continue during a furlough or layoff. It’s also important to determine whether the carrier will allow coverage to continue as long as premiums continue to be paid. For a self-funded/self-insured plan, the employer should look at its own summary plan description, plan document and Stop-Loss Insurance policy to determine how coverage is affected during a furlough or layoff. To Read More Click Here

February 19, 2025 by Matt Gibbs - At Blue Shield of California, we strive to ensure all Californians have access to high-quality health care at an affordable price. Delivering affordable, transparent pharmacy care is a primary component of that mission. Pharmacy is often the most frequent touchpoint within our healthcare journey. Yet, for many of us, the experience is costly, opaque and hard to navigate. That’s why Blue Shield of California set out to reimagine the prescription drug experience with the goal of building a pharmacy ecosystem that prioritizes better value for our members. Much of our initial work has focused on challenging the traditional supply-chain model, transforming how different players in this complex ecosystem work together — all in the service of our members. From rethinking these intricate models to working with various collaborators to lower drug costs, we’re laying the groundwork now for a more sustainable and patient-forward system. What’s happening behind the scenes? Reimagining pharmacy care requires addressing the structural issues that have long plagued our healthcare system. One of the most significant shifts is breaking away from the traditional pharmacy benefit manager (PBM) model — a model that has given rise to three major PBMs, which together control 80% of the market. While their mandate is to lower drug costs for employers and health plans, PBMs instead have operated as opaque intermediaries within the pharmacy supply chain. They profit from complex pricing structures that often increase the cost of drugs for patients. These conglomerates draw negative attention for practices like prioritizing medications that deliver the most profit to themselves, tacking on hidden fees, and pocketing part of the discounts they negotiate with drug manufacturers and retail pharmacies — savings that should be passed on to consumers. (Read more about how PBMs affect your health care here.) This model doesn’t work for anyone but PBMs. It doesn’t work for health plans or employers; it’s not good for drug manufacturers or pharmacies. Most importantly, it’s bad for consumers. Because of this, Blue Shield set out to unbundle the services traditionally handled by PBMs and instead build a new pharmacy service model that allows Blue Shield to provide members and employers with accurate drug pricing for truly informed decisions. You might already be seeing these changes. Last year, for example, we announced a collaboration with drug manufacturer Fresenius Kabi and Evio Pharmacy Solutions to purchase a Humira biosimilar for a transparent net price of $525 per monthly dose — far less than the approximately $2,100 monthly cost previously associated with Humira when traditional PBMs are involved. Now, most Blue Shield members can access this biosimilar option at a fraction of the cost. As part of that work, we’re leveraging state-of-the-art technology to make the pharmacy care experience much more convenient and streamline how prescription drugs are delivered to our members. Here’s what you can expect in the coming year. To Read More Click Here