Benefit change could raise costs for patients getting drug copay assistance

Health plans may change with time. Know what to expect and how to respond with these tips on how to avoid unexpected changes.


Since Kristen Catton started taking the drug Gilenya two years ago, she’s had only one minor relapse of her multiple sclerosis, following a bout of the flu.

She can walk comfortably, see clearly and work part time as a nurse case manager at a hospital near her home in Columbus, Ohio. This is a big step forward; two drugs she previously tried failed to control her physical symptoms or prevent repeated flare-ups.

This year, Catton, 48, got a shock. Her health insurance plan changed the way it handles the payments that the drugmaker Novartis makes to help cover her prescription’s cost. Her copayment is roughly $3,800 a month, but Novartis helps reduce that out-of-pocket expense with payments to the health plan. The prescription costs about $90,000 a year.

Those Novartis payments no longer counted toward her family plan’s $8,800 annual pharmacy deductible. That meant once she hit the drugmaker’s payment cap for the copay assistance in April, she would have to pay the entire copayment herself until her pharmacy deductible was met.

Catton is one of a growing number of consumers taking expensive drugs who are discovering they are no longer insulated by copay assistance programs that help cover their costs. Through such programs, consumers typically owe nothing or have modest monthly copayments for pricey drugs because many drug manufacturers pay a patient’s portion of the cost to the health plan, which chips away at the consumer’s deductible and out-of-pocket maximum limits until the health plan starts paying the whole tab.

Under new “copay accumulator” programs, that no longer happens.

In these programs, the monthly copayments drug companies make don’t count toward patients’ plan deductibles or out-of-pocket maximums. Once patients hit the annual limit on a drugmaker’s copay assistance program, they’re on the hook for their entire monthly copayment until they reach their plan deductible and spending limits.

Catton put the $3,800 May copayment on a credit card. She knows her insurer will start paying the entire tab once she hits the pharmacy deductible. But, she said, she can’t afford to pay nearly $9,000 a year out-of-pocket for the foreseeable future.

“I’m talking to my doctor to see if I can I take it every other day,” she said. “I guess I’m winging it until I can figure out what to do.”

Drug copay assistance programs have long been controversial.

Proponents say that in an age of increasingly high deductibles and coinsurance charges, such help is the only way some patients can afford crucial medications.

But opponents say the programs increase drug spending on expensive brand-name drugs by discouraging people from using more cost-effective alternatives.

Switching to a cheaper drug may not be an option, said Bari Talente, executive vice president for advocacy at the National Multiple Sclerosis Society.

“Generally the multiple sclerosis drugs are not substitutable,” she said. “Most have different mechanisms of action, different administration and different side effect profiles.” Generics, when they’re available, are pricey too, typically costing $60,000 or more annually, she said.

Most MS drug annual copay assistance limits, if they have them, are between $9,000 and $12,000, Talente said.

Employers argue that the drug copayment programs are an attempt to circumvent their efforts to manage health care costs. For example, employers may try to discourage the use of a specialty drug when there’s a lower-cost drug available by requiring higher patient cost sharing.

There’s also the issue of fairness.

“From an employer perspective, everyone under the plan has to be treated the same,” said Brian Marcotte, president and CEO of the National Business Group on Health (NBGH), which represents large employers.

If someone needs medical care such as surgery, for example, that person doesn’t get help covering his deductible, while the person with the expensive drug might, he said.

According to an NBGH survey of about 140 multistate employers with at least 5,000 workers, 17 percent reported they have a copay accumulator program in place this year, Marcotte said. Fifty-six percent reported they’re considering them for 2019 or 2020.

If there is no comparable drug available, drug copayment programs may have a role to play if they can be structured so that participating patients are paying some amount toward their deductible, Marcotte said. But, he said, assistance programs for drugs that are available from more than source, such as a brand drug that is also available as a generic, shouldn’t be allowed.

In 2016, 20 percent of prescriptions for brand-name drugs used a drug copay assistance coupon, according to an analysis by researchers at the USC Schaeffer Center for Health Policy and Economics. Among the top 200 drugs based on spending in 2014, the study found that 132 were brand-name drugs, and 90 of them offered copay coupons. Fifty-one percent of the drugs with copay coupons had no substitute at all or only another brand drug as a close therapeutic substitute, the analysis found.

Advocates for people with HIV and AIDS say copay accumulators are cropping up in their patients’ plans and beginning to cause patients trouble. Drugs to treat HIV typically don’t have generic alternatives.

The biggest impact for the community their organizations serve may be for PrEP, a daily pill that helps prevent HIV infection, said Carl Schmid, deputy executive director at the AIDS Institute, an advocacy group. A 30-day supply of PrEP (brand-name Truvada) can cost nearly $2,000. Drug manufacturer Gilead offers a copay assistance program that covers up to $3,600 annually in copay assistance, with no limit on how much is paid per month.

“They’re at risk for HIV, they know it and want to protect themselves,” Schmid said. “It’s a public health issue.”

Earlier this month, the AIDS Institute was among 60 HIV organizations that sent letters to state attorneys general and insurance commissioners across the country asking them to investigate this practice, which has emerged in employer and marketplace plans this year.

Compounding advocates’ concerns is the fact that these coverage changes are frequently not communicated clearly to patients, Schmid said. They are typically buried deep in the plan documents and don’t appear in the user-friendly summary of benefits and coverage that consumers receive from their health plan.

“How is a patient to know?” Schmid asks. They learn of the change only when they get a big bill midway through the year. “And then they’re stuck.”

SOURCE:
Andrews M (25 MAY 2018). [Web Blog Post]. Retrieved from address https://khn.org/news/benefit-change-could-raise-costs-for-patients-getting-drug-copay-assistance/


April 2018 Safety Matters: Elevator Best Practices

Elevator Best Practices

Millions of employees use elevators each day at work. While elevators are considered one of the safest forms of transportation, it is important to follow best practices and safety precautions when using an elevator.

Boarding the Elevator

Take note of the following procedures for entering an elevator:

  • Make sure you are aware of the risks associated with riding the elevator prior to boarding, such as falls and accidents.
  • Allow all passengers to fully exit the elevator before you begin boarding.
  • Watch your step when entering the elevator, as it may not be exactly level to the floor.
  • Steer clear of the doors once you enter the elevator. Keep all clothes, carry-ons and body parts within the car. Never attempt to stop a closing door.
  • Pay attention to the elevator’s capacity limit. Do not attempt to board an elevator that has reached capacity.

Riding the Elevator

Keep in mind the following procedures for riding an elevator:

  • Stand as close to the elevator wall as possible. Be sure to leave as much room as possible for others.
  • Pay close attention to floor indications and transitions to ensure you are able to exit at the right time.
  • Press the “door open” button in the event of the elevator stopping on a floor without opening its doors.
  • Be courteous of other passengers on the elevator. Do not push other riders in front of you when exiting and be sure to move out of the way of passengers when they exit the elevator.

Watch your step as you exit to avoid tripping on uneven ground.

In Case of Emergency

Although rare, elevator accidents and malfunctions do happen. Keep in mind the following procedures in the event of an elevator emergency:

  • Never use an elevator in the event of a fire. Always take the stairs.
  • Remain calm at all times. If you are in a stalled elevator, utilize the alarm button or phone button to contact emergency services.
  • Reassure those who are panicked in the situation. Remind everyone that they are safe inside the elevator.
  • Do not engage in horseplay.
  • Do not try to exit the elevator or pry open the doors. Always wait for trained professionals to arrive.

While elevators are considered one of the safest forms of transportation, it is important to encourage best practices and safety precautions to all employees or building occupants that frequent the elevator.

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You May Want To Rethink Your 'Cultural Fit' Mentality, and Here's Why

 

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Why achieving diversity in tech requires firing the industry’s ‘cultural fit’ mentality

If you have interviewed for a technology job, there’s a good chance the words “culture” and “fit” made an appearance during the phone-screen phase, or in early rounds of interviews. It is no longer enough for a candidate — especially early to mid-career — to arrive to job interviews with a stellar resume and relevant technical skills. They might also have to come with their best “I’m normal and will fit into the overall team culture of this company” outfit on. Over the past decade, the idea of hiring for “cultural fit” has become as important as, and at times superseded, hiring to fit a job description across forward-looking industries, from tech to transportation.

The nuance of this shift may be a cause for concern — especially for a global tech sector in search of a clear route to workforce diversity. Many of today’s tech human resources teams are tasked with recruiting a diverse group of people and retaining star employees. However, they still tend to supplement those pursuits with cultivating a unified office culture. While the industry has largely moved on from using ping pong tables as a recruiting tool, hiring people who pass the Beer Test — an applicant that hiring managers could work with in the office and hang with at happy hour — remains commonplace. Further, hiring based on a hiring manager’s own narrow set of requirements needed to fit their idea of a relatable person opens the door to all sorts of unconscious biases. Taking this recruiting shortcut also raises the bar for candidates from already under-represented groups, including minorities and women.

The main casualties: the pursuit of diversity and business bottom lines. It is true that research-backed conventional wisdom suggests happy workplaces are productive workplaces. What that line of thinking doesn’t account for is the fact that exclusively hiring talent for interpersonal compatibility can negatively impact the quality of work and focus of employees. In other words, employee camaraderie does not equal workplace compatibility. It definitely does not equal workforce diversity. And while a company may benefit from a general aspect of like-mindedness, there’s a great chance that the actual work is suffering due to the lack of diversity — both in people and ideas. Here in Toronto, hiring managers still focus heavily on likeability, which at times can be seen as more important than technical skills. My team and I recently began to see to potential impacts of “cultural fit” as we started to dive into the findings of our new report on the state of talent in Toronto’s emerging tech sector.

—techcrunch.com


6 Steps to a More Effective Performance Management Program

 

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Traditional methods of managing performance aren’t working anymore. Companies are moving away from traditional performance management tools, like annual reviews, to new techniques that emphasize real-time feedback. You know the drill: managers and employees sit down once a year to review performance. These performance reviews assess an employee’s performance on a scale, or give it a numerical rating. And then, in some cases, employees are given a ranking compared to other employees.

A performance system used in figure skating or competitive cooking shows may not be the best way of evaluating employees in the workplace. When it comes to the traditional performance review process, consider: Traditional performance management approaches aren’t effective because they weren’t designed for the current workforce. Today, with a tight labor supply and the nature of work very different from the industrial past, organizations must focus on developing people, rather than rating them. This requires a shift to performance development. Here’s how you as an HR professional can help your management team create a thoughtful performance development plan.

This is important for two reasons: to make the case to management that there is room for improvement in your current performance management system and, later, to provide baseline metrics to which you can compare your system after the shift to performance development. Your audit should ask the following questions: As part of your evaluation, also assess current organizational performance. A shift to performance development will see organizational performance metrics improve, and you want to be able to quantify this improvement.

Let your senior management team know that performance management may no longer be meeting your company’s needs. Two-thirds of companies are shifting from traditional performance management to an emphasis on developing talent and providing continuous feedback. Then present the results of your audit to senior management. What are the areas that need to be improved? Provide examples of how performance development will help improve these areas. For instance, if your employees rarely receive feedback outside of their annual performance review, show how alternatives to the review, such as consistent coaching or monthly or weekly , can provide your employees with regular feedback.

—tlnt.com


Stress-free approach to reach business goals

It is not uncommon to struggle with setting and reaching your business goals. This article discusses a goal-setting strategy based upon three levels: small, medium, and large-sized goals.


Settling goals is an act in contradiction: Make standards too high and you’ll get frustrated on the climb, yet make standards too low and you’ll be disappointed with your long-term results. As more than one productivity guru has put it, the problem with low expectations is that you’ll actually reach them.

One solid approach to take, though, is to actually do both: Create high expectations while still making reachable milestones. To do that, plan out three levels of increasing goals.

The lowest goals are the ones you can reach based on your current momentum. These intentions don’t require a major strategy shift. The main point is to give yourself credit for your level of progress and to give you milestones to celebrate – and you should be celebrating every victory, no matter how small.

The medium-sized goals are the milestones that require some higher effort on your part. Working harder may get you there, but you may need to reconsider your current approach to your work to meet them. These goals give you a higher ambition that, with a bit of effort, can be reached.

The large goals are the big vision you see for yourself. Don’t hold back here: The goals should make you equally nervous and excited. It also should be big enough to require a major change in your strategy. In other words, working harder isn’t going to cut it – you’ll have to work smarter to get there.

The beauty here is that each set of goals builds on the previous one: Reaching the lowest goal sets you up to think bigger for the medium-sized goal and gives you the momentum necessary to even fathom the large goal. And you are a winner no matter how far you reach.

Read the article.

Source:
Brown D. (22 February 2018). "Stress-free approach to reach business goals"[Web Blog Post]. Retrieved from address http://workwell.unum.com/2018/01/stress-free-approach-to-reach-business-goals/


3 simple ways to get motivated

Getting and staying motivated can be tough, whether you are coming back from vacation, dealing with something you’d rather avoid or getting focused on a Monday. Not every day will be super productive, and there is no sense in punishing yourself because of it, but there are three great ways to get back on track.

One way is to take the simplest task and make it even simpler. For example, if you have to write an email, then focus on doing the first sentence. Make writing the first sentence your goal. It may feel ridiculously easy, which is the point: Once you write that first sentence, then you will likely have the confidence to begin on the second sentence, and so on.

Another approach is to think about being in bed, tonight, right before you go to sleep. What did you accomplish today? Did you feel good about what got done? What do you wish you had gotten done so you wouldn’t be worried about doing it tomorrow? Now you can stop imagining: It’s wonderful that you still have the day ahead of you and you can get things done now.

Lastly, work on your next task for only five minutes. It will be a focused five minutes, which means no multitasking. Set an alarm as necessary. Chances are that the five minutes will go by quickly and, if you like, you can set the alarm for another five minutes.

Our motivation is usually hampered by either inertia, like when we have taken a break, or by timidity, like when we are intimidated by a major goal. By using these three methods, you can move towards success and focus on the next small step towards your big successful goal.

Read the article.

Source:
Brown D. (21 February 2018). "3 simple ways to get motivated" [Web Blog Post]. Retrieved from address http://workwell.unum.com/2018/02/3-simple-ways-to-get-motivated/


6 Steps to a More Effective Performance Management Program

 

300x200

Traditional methods of managing performance aren’t working anymore. Companies are moving away from traditional performance management tools, like annual reviews, to new techniques that emphasize real-time feedback. You know the drill: managers and employees sit down once a year to review performance. These performance reviews assess an employee’s performance on a scale, or give it a numerical rating. And then, in some cases, employees are given a ranking compared to other employees.

A performance system used in figure skating or competitive cooking shows may not be the best way of evaluating employees in the workplace. When it comes to the traditional performance review process, consider: Traditional performance management approaches aren’t effective because they weren’t designed for the current workforce. Today, with a tight labor supply and the nature of work very different from the industrial past, organizations must focus on developing people, rather than rating them. This requires a shift to performance development. Here’s how you as an HR professional can help your management team create a thoughtful performance development plan.

This is important for two reasons: to make the case to management that there is room for improvement in your current performance management system and, later, to provide baseline metrics to which you can compare your system after the shift to performance development. Your audit should ask the following questions: As part of your evaluation, also assess current organizational performance. A shift to performance development will see organizational performance metrics improve, and you want to be able to quantify this improvement.

Let your senior management team know that performance management may no longer be meeting your company’s needs. Two-thirds of companies are shifting from traditional performance management to an emphasis on developing talent and providing continuous feedback. Then present the results of your audit to senior management. What are the areas that need to be improved? Provide examples of how performance development will help improve these areas. For instance, if your employees rarely receive feedback outside of their annual performance review, show how alternatives to the review, such as consistent coaching or monthly or weekly , can provide your employees with regular feedback.

—tlnt.com


Spot the differences between productivity and busyness

Productivity and busyness are often used interchangeably. This is a mistake. When you think about it, you can be busy and still get nothing really done.

Productivity is efficiently using time to change something, whether it be improving a project or taking care of an errand. Efficiency is the key word here, as no one would consider, say, spending an entire day writing a letter efficient.

Busyness is being occupied with a particular activity to the point where it becomes a priority. Spending an entire day writing a letter is busyness, but it wouldn’t be considered productive. Yet, we can say “It was a busy day” and it could be, mistakenly, interpreted as productivity.

The difference matters because productivity requires strategy: What works best, what is most important now, what matters over other tasks and other standards. Busyness prioritizes going forward, whether or not it is the best thing to do right now.

Being productive rather than busy requires stopping, strategizing and consideration before taking action. To be truly productive, you must not be afraid of pausing – and pausing feels like the opposite of being busy. You must let go of the need to feel busy.

One other simple tell: Productivity tends to give energy, while busyness tends to take it away. Getting things accomplished creates momentum as well as confidence, while doing busy work often makes inertia and frustration since it usually doesn’t lead to progress.

Read the article.

Source:
Brown D. (21 February 2018). "Spot the differences between productivity and busyness" [Web Blog Post]. Retrieved from address http://workwell.unum.com/2018/02/spot-the-differences-between-productivity-and-busyness/


Algorithmic Bias – What is the Role of HR?

How should HR professionals deal with the forthcoming algorithmic bias issue? Find out in this article.


Merriam-Webster defines ‘algorithm’ as step-by-step procedure for solving a problem…In an analog world, ask anyone to jot down a step-by-step procedure to solve a problem – and it will be subject to bias, perspective, tacit knowledge, and a diverse viewpoint. Computer algorithms, coded by humans, will obviously contain similar biases.

The challenge before us is that with Moore’s Law, cloud computing, big data, and machine learning, these algorithms are evolving, increasing in complexity, and these algorithmic biases are more difficult to detect – “the idea that artificially intelligent software…often turns out to perpetuate social bias.”

Algorithmic bias is shaping up to be a major societal issue at a critical moment in the evolution of machine learning and AI. If the bias lurking inside the algorithms that make ever-more-important decisions goes unrecognized and unchecked, it could have serious negative consequences, especially for poorer communities and minorities.”What is the role of HR in reviewing these rules? What is the role of HR in reviewing algorithms and code? What questions to ask?

In December 2017, New York City passed a bill to address algorithmic discrimination.Some interesting text of the bill, “a procedure for addressing instances in which a person is harmed by an agency automated decision system if any such system is found to disproportionately impact persons;” and “making information publicly available that, for each agency automated decision system, will allow the public to meaningfully assess how such system functions and is used by the city, including making technical information about such system publicly available where appropriate;”

Big data, AI, and machine learning will put a new forward thinking ethical burden on the creators of this technology, and on the HR professionals that support them. Other examples include Google Photos incorrect labeling or Nikon’s facial detection. While none of these are intentional or malicious, they can be offensive, and the ethical standards need to be vetted and reviewed. This is a new area for HR professionals, and it’s not easy.

As Nicholas Diakopoulos suggests, “We’re now operating in a world where automated algorithms make impactful decisions that can and do amplify the power of business and government. As algorithms come to regulate society and perhaps even implement law directly, we should proceed with caution and think carefully about how we choose to regulate them back.”

The ethical landscape for HR professionals is changing rapidly.

Read more.

Source:

Smith R. (15 February 2018). "Algorithmic Bias – What is the Role of HR?" [Web Blog Post]. Retrieved from address https://blog.shrm.org/blog/algorithmic-bias-what-is-the-role-of-hr

5 Tips to Improve the Employee Experience from an Employee Happiness Director

From SHRM, here are some helpful tips to improve happiness within your workplace.


 

Gone are the days of delighting customers at the expense of employees. Organizations today understand the value of employee happiness and are increasingly looking for ways to attract and retain top talent. This includes delighting employees at every touch point along the way from orientation and beyond.

And while this may mean something different for every organization, the following few tips may help to improve the employee experience, and if your employees are happy, your investors, customers and clients will follow.

Find employees who follow your north star. Hire employees who align with your core values. Our organization is mission-driven and focused on transforming lives. As a result, we look for good eggs who are driven by doing something for the greater good and leaving the world a better place. Big egos need not apply.

Prioritize happiness. Happiness means something different to every employee. Encourage your employees to find what makes them happy and prioritize that. Employee happiness is our CEO’s number one priority, so we held a workshop to design our culture of happiness together with input every single employee. We now measure employee happiness monthly and look for ways to delight our employees at every turn.

Ask and you shall receive. We constantly ask our employees about what’s working, what’s not working and how we can come together to build a culture of happiness through weekly, anonymous surveys. This provides leadership with valuable insights and empowers employees at all levels to help create an environment where we will thrive. Commit to delivering on employee suggestions that impact happiness when you can. You may not always be able to implement a suggestion but always ensure that the employee’s input is valued and was heard by leadership.

Be culturally relevant. While some may appreciate yoga breaks during all company meetings, others may want time off to volunteer with family and friends. Get to know your employees and understand what is truly meaningful to them. And always check back - life moves fast and personal priorities shift. Make sure your benefits and perks evolve to keep up with your dynamic population.

Give that gold star. It’s not all about perks. Offer work that’s challenging, acknowledge a job well done and reward employees in creative ways that are motivating to them. A company that successfully fosters a positive employee experience reaps the benefits in the form of enhanced engagement, happiness, productivity and retention.

 

Read the original article.

Source:
Andrade C. (4 December 2017). "5 Tips to Improve the Employee Experience from an Employee Happiness Director" [Web blog post]. Retrieved from address https://blog.shrm.org/blog/5-tips-to-improve-the-employee-experience-from-an-employee-happiness-direct