August 2023 Insurance Information & News

New Jersey Passes Prescription Drug Reform Legislation

New Jersey’s Governor Phil Murphy signed a trio of bills on July 10, 2023, to combat high prescription drug costs. The legislation includes capping medication prices for state-regulated public employee plans, regulating pharmacy benefit managers (PBMs), and enhancing prescription drug price transparency. These measures will be phased in throughout 2024 and 2025. Notably, S. 1614 will limit insulin, epinephrine pens, and asthma inhaler costs for individuals under New Jersey-regulated publicly offered plans. A. 536 requires PBMs to be licensed by the State Department of Banking and Insurance, banning “spread pricing” practices. S. 1615 mandates comprehensive price and claims disclosure for greater consumer insight and establishes a state Drug Affordability Council to advise lawmakers.

Biden Admin Issues New FAQ Guidance

On July 10, 2023, the U.S. Departments of Health and Human Services, Labor, and Treasury issued FAQ guidance to clarify healthcare consumer protection regarding surprise billing and facility fees. The guidance specifies that payments for services from participating providers under surprise billing protections count as in-network cost-sharing for out-of-pocket limits. Cost-sharing for services from nonparticipating providers is considered out-of-network cost-sharing. For instance, if an individual receives services from an out-of-network provider at an in-network hospital, the payment would count towards their out-of-network maximum.

The guidance also addresses hospital facility fees charged to individuals receiving care in hospital-owned facilities outside traditional hospital settings. These fees are considered medical care costs and must be disclosed in transparency tools required by federal regulations.

Overall, the guidance aims to provide clarity on consumer rights and responsibilities regarding healthcare costs, especially in situations involving surprise billing and facility fees.


Expensive Weightloss Drugs Impacting Medical Renewals

Employers are facing rising healthcare costs due to increased interest in weight loss drugs like Ozempic and Wegovy. These medications are part of a class known as GLP-1s, used to treat diabetes and support weight loss. However, the abuse of these drugs, coupled with their high cost (averaging $17,000 annually), is a concern for employers. With around 40% of American adults being obese, obesity-related medical costs are substantial, leading some employers to spend over $100,000 on Ozempic in a single month. To address this issue, some companies are turning to benefit providers and innovators for alternative solutions to manage weight and obesity. Digital support and access are also being explored to reduce stigma and provide more personalized care and interventions. Employers are encouraged to develop sustainable plans to support sustained change and weight loss beyond medication use.

Compliance Corner

The Affordable Care Act (ACA) requires all employers with 50 employees or more to provide affordable healthcare coverage. But did you know there are penalties for not filing?

Here are the penalties for late, incorrectly, or not filling the 1094/1095-C form for 2023.

Year DueUp to 30 Days Late31 Days Late Thru August 1After August 1 or Not FiledIntentional Disregard

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