GLP-1 Drugs: Navigating Costs and Coverage in Employer Health Plans
The surge in popularity of GLP-1 weight loss drugs, like Wegovy and Ozempic, presents a significant cost challenge for employers. With monthly expenses around $1,000 per user, these drugs are impacting health plan renewals. Insurers are increasingly restricting coverage, particularly for non-diabetic or non-cardiovascular patients.
In our article written by Robert DeNinno, physicians acknowledge GLP-1’s benefits but highlight potential side effects and long-term uncertainties. Employers must balance immediate costs against potential long-term health savings, consider affordability, and assess the impact on company culture. A collaborative approach involving HR, finance, and benefits consultants is crucial for informed decision-making.
Read the full article for a deeper dive into GLP-1 drug considerations.
Jefferson Network Update Cigna
As of March 15th, the network with Cigna Health Care experienced an out-of-network status with Jefferson. However, Cigna confirms they are close to a deal. Word is Cigna is nearing finalization. Contracting is complex, involving intricate details.
Enhanced Security for IBX Member Portal Registration
Independence Blue Cross has implemented a security enhancement to protect member data on its website and mobile application. Effective March 22nd, new account registrations will undergo a one-day validation period before access is granted. Members will receive email confirmation upon successful account activation. For immediate assistance, members can contact 1-844-214-2389.
Updated marketing materials are available for agents to share with clients, highlighting the benefits of online and mobile platform utilization for managing healthcare and accessing digital ID cards, applicable to both Independence Blue Cross and Independence Administrators plans.
And AmeriHealth Enhances Member Portal Security
Similarly to IBX, effective March 22, 2025, AmeriHealth implemented a one-day validation period for new member account registrations on their website and mobile application. This measure is designed to enhance the security of member personal information. Members will receive email confirmation upon successful account activation. For immediate assistance, members can contact 1-844-214-2389.
Updated marketing materials are available, emphasizing the benefits of online and mobile platform utilization for managing healthcare and accessing digital ID cards, applicable to both AmeriHealth and AmeriHealth Administrators plans.
ACA Subsidy Expiration: State Impact Projections
The expiration of enhanced Affordable Care Act (ACA) marketplace subsidies at the end of 2025, unless extended, will significantly increase monthly premiums for most enrollees starting in 2026. Projections indicate a 93% average premium increase for subsidized enrollees in Healthcare.gov states. The Congressional Budget Office estimates 3.8 million more uninsured individuals annually. State-based subsidies won’t fully offset this loss. An interactive map and calculator in this resource provide detailed impact analyses by congressional district and individual scenarios.
Compliance Corner! Tobacco Surcharge Lawsuits Highlight Compliance Risks
Class-action lawsuits challenge employer tobacco premium surcharges, alleging HIPAA violations. Plaintiffs argue surcharges lack reasonable alternatives and proper notification. Employers can impose surcharges if compliant with HIPAA’s wellness program rules: annual opportunity, reward limits, alternative standards, reasonable design, and clear notification. DOL enforcement and large settlements underscore the financial risks of non-compliance.