The Partners Insurance Rx Solutions Analytics Predictive Model program has changed the pharmaceutical procurement industry with our latest innovation, Average Script Price Guaranteed contracts.

Average Script Price Guarantees

• transfer the risk for drug price inflation from the employer to the PBM;
• are equivalent to aggregate reinsurance with no premium;
• fix your Rx cost and allow for accurate budgeting;
• eliminate PBM conflict of interest on drug manufacturer rebates;
• eliminate Average Wholesale Price (AWP) and formulary bias;
• create real competition in the market and allow bidders to compete using actual claims cost as the basis of their bids.
   

The Partners Insurance Rx Solutions Analytics program through Average Script Price contracts will create significant savings for your company.

• Audits on contract compliance can be run monthly, quarterly or annually and no self reporting by the PBM.
• The winning PBM guarantees the financial performance of their bid on a first dollar basis with no cap.
• No plan design changes and no disruption of retail pharmacy access to your employees.
• Our program provides a level playing field and takes the "games" out of the RFP process.
• Program fees paid by winning bidder and all the savings go directly to the employer's bottom line.
• Fully or self insured employers with 1000+ employees or at least $1 million in prescription spending qualify.

Contact Morgan Pile at 877-491-9279 to take control of your RX spending!

Benefits Roundtable Webinar Series
Earlier this year, the Centers for Medicare & Medicaid Services (CMS), the Federal Trade Commission (FTC), the Department of Justice (DOJ) and the HHS Office of the Inspector General (OIG) issued proposed regulations dealing with the Medicare shared savings program, also known as accountable care organizations (ACOs) under Section 3022 of the Affordable Care Act of 2010.
 
Under the proposed rules, eligible providers, hospitals, and suppliers that participate in the shared savings program by creating or joining an ACO can continue to receive traditional Medicare fee-for-service payments under Medicare Parts A and B and qualify for additional payments based upon specified quality and savings requirements. This Webinar will analyze the proposed rule as well as the calls being made by several groups for changes to it. Among other things, the Webinar will address:

• The complexity of the program and what appears to be a bias against medical group participation.
• The excessively high cost of both ACO development and ongoing operation relative to the potential financial benefits.
• The small and uncertain financial benefits.
• The substantial regulatory risks under related joint notices from CMS and the Office of Inspector General (OIG), and the Federal Trade Commission (FTC) and the Department of Justice (DOJ) that deal with antitrust and fraud and abuse enforcement.
  

  CMS' part of the final rules are due to be issued within the next several weeks.
   
  Date: Wednesday, October 5, 2011
  Time: Noon - 12:40 PM CST
  Registration: Click Here

We are proud to announce that Morgan Pile will be a keynote speaker at the World Health Tourism Congress in Spain this year!
 
The World Health Tourism Congress is the most established and longest running health and medical tourism event in the world. This international event will be addressing 8 health-related tourism segments in sunny southern Spain!

• Medical Tourism
• Dental Tourism
• Spa Tourism
• Wellness Tourism
• Sports Tourism
• Culinary Tourism
• Accessible Tourism
• Assisted Residential Tourism

This premier event offers healthcare providers from around the world the chance to create business opportunities and form partnerships with the largest corporate healthcare buyers in the world.  The WHTC is the first and ONLY event focused on bringing corporate purchasers of healthcare together with world class medical providers.
 
This event takes place June 17-19 in Murcia, Spain.  For more information on the event, please visit the WHTC website.

Benefits Roundtable Webinar Series
This roundtable discussion will explain the requirements and the employer's responsibilities relating to the new participant reporting requirements for 401(k) plans.
 
The format is open-ended with an introduction of current legal and regulatory issues presented by Tod Yeslow of Mitchell Williams and current trends in benefits strategy, design, and funding discussed by Morgan Pile of Partners Insurance. You are invited to listen-in, ask questions, and suggest future discussion topics of particular interest to you. We hope this opportunity will create a lively and robust forum that can become a reliable source for you to stay up-to-date on current developments or issues of concern, expose new ideas in benefits strategy, be used as a tool to address your specific issues, and support network building among your peers.
 
Date: Wednesday, June 1, 2011
Time: Noon - 12:40 PM CST
To Register Click Here

by Brian A. Vandiver of Mitchell Williams

On March 24th, the EEOC's final regulations for the ADA Amendments Act ("ADAAA") were made public. The EEOC originally proposed its implementing regulations (the Notice of Proposed Rulemaking or "NPRM") for the ADAAA on September 23, 2009. After receiving hundreds of comments and conducting several public meetings, the EEOC revised its regulations. According to the EEOC, the "final regulations modify or remove language that groups representing employer or disability interests had found confusing or had interpreted in a manner not intended by the EEOC." The EEOC provides the following examples of how the final regulations differ from the NPRM:

· Instead of providing a list of impairments that would "consistently," "sometimes," or "usually not" be disabilities (as had been done in the NPRM), the final regulations provide the nine rules of construction to guide the analysis and explain that by applying those principles, there will be some impairments that virtually always constitute a disability. The regulations also provide examples of impairments that should easily be concluded to be disabilities, including epilepsy, diabetes, cancer, HIV infection, and bipolar disorder.

· Language in the NPRM describing how to demonstrate that an individual is substantially limited in "working" has been deleted from the final regulations and moved to the appendix (consistent with how other major life activities are addressed). The final regulations also retain the existing familiar language of "class or broad range of jobs" rather than introducing a new term, and they provide examples of individuals who could be considered substantially limited in working.

· The final regulations retain the concepts of "condition, manner, or duration" that the NPRM had proposed to delete and explain that while consideration of these factors may be unnecessary to determine whether an impairment substantially limits a major life activity, they may be relevant in certain cases.

At first glance, many of the revisions contained in the ADAAA's final regulations appear to be somewhat favorable to employers and the ADA's other covered entities. Nonetheless, there is little dispute that the ADAAA and its final regulations have made and will to continue to make defending ADA claims more difficult. Employers and other covered entities under the ADA should review their policies and practices to ensure compliance with the ADAAA and its final regulations.

The EEOC's press release is available here: http://www.eeoc.gov/eeoc/newsroom/release/3-24-11.cfm

The EEOC's final regulations for the ADAAA and other documents relating to the ADAAA and its final regulations are available here: http://www.eeoc.gov/laws/statutes/adaaa_info.cfmEmployers

Don't forget about our May webinar!  We have partnered with Mitchell Williams to produce "Pay or Play: Am I Compliant?". 

Employers are scrambling to understand the extent to which PPACA applies to them and decide whether they will "play-or-pay". They must also determine how to comply with the requirements of PPACA and still meet their business purposes for offering health benefits to their employees.  On May 5, learn more about:  

· Legislative and Judicial updates to Health Care Reform
· Recap of "play or pay rules" and next steps for employers
· Pricing a private health care provider against the State Insurance Exchanges.

Date: May 5, 2011

Time: Noon - 12:40pm

To Register: Click Here!

Mitchell Williams and Partners Insurance invite you to join us for a monthly benefits roundtable webinar series designed exclusively for company benefits managers.  This roundtable discussion is designed to provide benefits professionals with an opportunity to learn and discuss current issues and trends in benefits law and strategy. The first webinar in this series will be held April 7.

Are You Ready for PPACA?

Learn more about an employer's legal responsibilities under Health Care Reform and the strategies for meeting those responsibilities.  We will be covering:

· The requirements for individual policies
· The rules applicable to group health plans
· The factors to consider in calculating the number of employees
· What constitutes a "grandfathered" plan
· The advantages of being a grandfathered plan
· How to preserve one's grandfathered status
· The "play or pay" provisions of the legislation
· What is required to play and how much to pay
· Management and fiduciary considerations in the plan design

Event Info

Date: April, 7, 2011

Time: Noon to 12:40pm

To Register: Click here

Employee Benefit Advisor - Federal Judge Finds PPACA Unconstitutional

On January 31, a Florida federal judge has ruled that the Patient Protection and Affordable Care Act is unconstitutional.  For more information, please visit the full article. 

CIGNA - U.S. Senate Blocks PPACA Repeal Effort
 
On February 2, 2011, the U.S. Senate defeated an amendment to an unrelated bill that would have repealed the Patient Protection and Affordable Care Act (PPACA) in its entirety. The result was not unexpected. The vote was along party lines, with all 47 Republicans voting to repeal and 51 Democratic Senators voting not to repeal. Two Senators - Joseph Lieberman (I-CT) and Mark Warner (D-VA) - did not vote. Sixty votes of approval were needed to overcome a procedural point of order. The action comes less than a month after the Republican-controlled House of Representatives passed a bill on January 19 to repeal the Obama Administration's health care reform legislation.

The Senate did, however, agree on a broad bipartisan basis to strip the law of a new tax reporting requirement (the so-called "1099 requirement") placed on businesses to report all cumulative purchases from vendors totaling more than $600 per year. While there is broad, bipartisan support for that provision in the House and Senate - and President Obama has indicated an openness to revisiting it - it appears it will take several months for that provision to progress through the legislative process.
 
For more information on the Healthcare Reform, please visit Cigna's Informed on Reform website.

Partners Insurance will be the PLATINUM SPONSOR for the Human Resource Management Association conference in Little Rock being held March 9-11.  For more information, please visit the HRMA website.

The House is voting to repeal Obama's healthcare laws.  For more information, please visit: http://news.yahoo.com/s/ap/20110119/ap_on_re_us/health_care_repeal