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Trump Administration Decides Not to End PBM Rebates

The Trump administration has decided not to pursue a policy that would have put an end to rebates paid to pharmacy benefit managers, which could put the focus again on how drug companies set their prices.

The proposal would have barred drug companies from paying rebates to PBMs that participate in Medicare and other government programs. According to the administration, the proposed rules were shelved because Congress had taken up the issue to control drug costs.

The spotlight has been harsh on some of the country’s largest PBMs, which have been accused of pocketing a substantial portion of the rebates for themselves while passing on only a sliver of the rebates to the insurance companies that hire them and the health plan enrollees that pay out of pocket for the drugs.

Rebates had become a popular target of criticism in Washington after drug companies lobbied aggressively to cast them as the reason for high prices. PBMs negotiate drug discounts in the form of rebates, often keeping some of that money for themselves.

However, many pundits say that the rebate system put in place by large, national PBMs incentivizes drug companies to keep list prices high, which in turn defeats the purpose of the PBMs – that is, to reduce the out-of-pocket costs that health plan enrollees pay for their prescription drugs.

Like insurers and PBMs, some of which have sought to undermine the practice with accumulator adjustment programs, the Trump administration believes such coupons may be driving up health care spending by getting patients to opt for higher-priced name-brand drugs over generics.

The Centers for Medicare & Medicaid Services proposal unveiled in January would have essentially blocked drug manufacturer rebates from going to PBMs and health plans that serve Medicare and Medicaid patients, starting next year.

Now that the push to eliminate rebates has come to end, the focus looks like it’s shifting to how drug companies price their products. We will keep you posted if any legislation surfaces in this area.


Get an Early Start on Open Enrollment

As open enrollment is right around the corner, now is the time to make a plan to maximize employee enrollment and help your staff select the health plans that best suit them.

You’ll also need to make sure that you comply with the Affordable Care Act if it applies to your organization, as well as other laws and regulations.

Here are some pointers to make open enrollment fruitful for both your staff and your organization.

Review what you did last year

Review the results of last year’s enrollment efforts to make sure the process and the perks remain relevant and useful to workers.

Were the various approaches and communication channels you used effective and did you receive any feedback about the process, either good or bad?

Start early with notifications

You should give your employees at least a month’s notice before open enrollment, and provide them with the materials they will need to make an informed decision.

This includes the various health plans that you are offering your staff for next year.

Encourage them to read the information and come to your human resources point person with questions.

Help in sorting through plans

You should be able to help them figure out which plan features fit their needs, and how much the plans will cost them out of their paycheck. Use technology to your advantage, particularly any registration portal that your plan provider offers. Provide a single landing page for all enrollment applications.

Also, hold meetings on the plans and put notices in your staff’s paycheck envelopes.

Plan materials

Communicate to your staff any changes to a health plan’s benefits for the next plan year through an updated summary plan description or a summary of material modifications.

Confirm that their open enrollment materials contain certain required participant notices, when applicable – such as the summary of benefits and coverage.

Check grandfathered status

A grandfathered plan is one that was in existence when the ACA was enacted on March 23, 2010, and is thus exempt from some of the law’s requirements.

If you have a grandfathered plan, talk to us to confirm whether it will maintain its grandfathered status for the next plan year. If it is, you must notify your employees of the plan status. If it’s not, you need to confirm with us that your plan comports with the ACA in terms of benefits offered.

ACA affordability standard

Under the ACA’s employer shared responsibility rules, applicable large employers must offer “affordable” plans, based on a percentage of the employee’s household income. For plan years that begin on or after Jan. 1 of next year, the affordability percentage is 9.86% of household income. At least one of your plans must meet this threshold.

Get spouses involved

Benefits enrollment is a family affair, so getting spouses involved is critical. You should encourage your employees to share the health plan information with their spouses, so they can make informed decisions on their health insurance together.

Also, encourage any spouses who have questions to schedule an appointment to get questions answered.


New Pay Data Due to EEOC by Sept. 30

Employers with more than 100 workers have to meet a Sept. 30, 2019 deadline to report detailed information on how they compensate workers – broken down by gender, race, and ethnicities – to the Equal Employment Opportunity Commission.  

The data is part of the EEO-1 form that employers have been required to file for years. There are now two components to the form: 

Component 1 – This information includes the number of employees who work in a business, broken down by category, race, sex, and ethnicity. The deadline for submitting this information was May 31. This is the same information employers have been filing for years. 

Component 2 – This newly required information includes hours worked and pay data from employees’ W-2 forms, broken down by race, ethnicity, and sex. This is due by Sept. 30. 

The second component, initiated by the Obama administration, was supposed to have taken effect in 2017, but after President Trump took office, he halted the roll-out of the rule, on the grounds that reporting such detailed salary information was a burden on companies.  

Several worker-advocacy groups filed suit, challenging the hold on the pay-data collection provisions. On March 4, 2019, a federal judge lifted the stay and ordered the EEOC to start collecting the data.  

Why does EEOC want the information? 

The EEOC says the detailed information on salaries will help its investigators determine which of the discrimination complaints that it receives merit further processing.  

The EEOC uses information about the number of women and minorities that companies employ to support civil rights enforcement and analyze employment patterns, according to the agency. 

The basics of EEO-1 

Businesses with at least 100 employees, and federal contractors with at least 50 employees and a contract of $50,000 or more with the federal government must file the EEO-1 form.  

To accommodate the new rules, the EEOC has revised the form, which will require employers to report wage information from box 1 of the W-2 form and total hours worked for all employees by race, ethnicity and sex within 12 proposed pay bands (example: $24,440-$30,679 is one band) and 10 occupation bands (like professionals, technicians or salespeople). 

Component 2 data 

Here’s what you will need to include in the component 2 data: 

  • Pay data 
    Employers must identify the number of employees (based on a combination of race and sex) that fall within each of 12 compensation bands for each EEO-1 job category. Employers will not be required to submit names or Social Security numbers for any employee.  
    To identify the compensation band in which to count an employee, employers must use Box 1 of Form W-2. Employers may not use gross annual earnings instead of Form W-2’s Box 1 earnings. 
  • Hours-worked data 
    Employers must list the total number of hours worked by employees (based on a combination of race and sex) within the same compensation band and job category. 

What to do 

The EEOC has created a web-based portal for filing the EEO-1 form along with instructions and fact sheets, all of which you can find here

The portal will remain open until the Sept. 30 filing deadline. If you have not already received login information, you can do so on the portal page. 


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