Phia Group

The Skinny on Weight Loss Drugs

On February 21, 2024
From Contrave to Saxenda to Wegovy and beyond, society is being bombarded with messaging about weight loss drugs. While many publicly debate their efficacy and long term viability, far fewer are openly asking who will pay for them – and how. For those of us that sponsor and service health benefit plans, the costs arising from this trend are very real. While we want to help people lose weight, get fit, and improve their overall health – the best way to approach this matter is still uncertain. Join The Phia Group for another free webinar! Our team will discuss this very relevant topic, including related issues such as off-label drug usage, international drug importation, defining medical necessity, plan drafting and exclusions. Likewise, the importance of educating plan membership about the costs of healthcare, and what it means to be self-funded.

Empowering Plans: P182 – Navigating Post-Settlement Fund Pursuits

On February 15, 2024
Attorneys Andrew Silverio and Cindy Merrell discuss a newly decided case which provides a roadmap for pursuing settlement funds after disbursement. Who has the burden of proof when the funds have been dissipated? What is lowest intermediate balance rule?

Welcome to the Subrogation Sphere

On February 9, 2024
Las Vegas does not have the only sphere that can provide an extraordinary experience for its participants. Let me introduce you to the subrogation sphere where participants may first appear to have conflicting interests but can become allies. When a health plan member is injured because of a third-party action it sets into motion a dance involving many players, potentially including the plan participant, at-fault party, medical providers, stop loss carrier, and the health plan. Each player is trying to determine which player is the proper payor of the plan participant’s medical expenses.

Empowering Plans: P181 – Chevron Deference in Peril – What It Could Mean for Healthcare Regulations

On February 1, 2024
In this episode of the Empowering Plans podcast, attorneys Brady Bizarro and Brian O’Hara discuss the legal doctrine involved in two cases now before the Supreme Court – Chevron deference. They’ll explain what it means, why it is important for federal agency action, and how it impacts the entire healthcare industry. With a decision expected by this summer, you do not want to miss our take on how the NSA, the Medicare drug price negotiations, and the ACA itself could be at stake.

Are Measles Making a Comeback?

On January 31, 2024
The ever-serious epidemiologist out of Minnesota, who forewarned of a global pandemic years ago and has garnered the not-so-flattering nickname “Bad News Mike,” has a new dire message about the recent measles outbreak, one to which children are most susceptible, that has started to trickle through pockets of Europe and, more recently, the US:

Empowering Plans: P180 – The Continuing Evolution of MHPAEA

On January 18, 2024
One might think they’re listening to a broken record when hearing Jennifer McCormick and Kelly Dempsey discuss the ever-shifting landscape of the Mental Health Parity and Addiction Equity Act (MHPAEA), but alas, this is a brand new podcast! As we start 2024, we are reframing our mindset and are making some changes to address the evolving MHPAEA regulations and insights we have received from regulating bodies through the NQTL Comparative Analysis Process. In addition to highlighting the significance of how these issues should be addressed within an employer’s PD/SPD, there are three main changes discussed to create visibility for employers creating new 2024 PD/SPDs.

A New Year Brings New (Higher) Prescription Drug Prices

On January 18, 2024
It must be January. W-2 forms are hitting the mail. Fitness centers are packed to the brim. The NFL playoffs are in full force.

Considerations Regarding the Exclusion of Gender-Affirming Care

On January 16, 2024
Gender-affirming care was a particularly popular topic throughout 2023. As we enter the new year, the prevalent discussion concerning plan coverage of such care will certainly continue.

Navigating 2024: The Latest, Most Innovative Plan Design Features & Stop-Loss Policy Updates

On January 16, 2024
In this first webinar of 2024, our crew will provide a rundown of 2024’s biggest plan document and stop-loss updates, including matters about which our team has been asked the most. Stay ahead of the crowd, and join The Phia Group as we jump into the year with a head start. Together we will resolve lingering problems of the past and equip you with a list of changes to expect and topics you need to monitor in 2024 and beyond.

The Phia Group's 1st Quarter 2024 Newsletter

On January 11, 2024
The Phia Group is off to a great start in the first quarter of 2024! Check out our newsletter to get acquainted with some of the latest happenings in our neck of the woods.

Empowering Plans: P179 – Higher Healthcare Prices (Made From Concentrate)

On January 4, 2024
The trend of provider consolidation is primed to pick up pace in 2024, distilling some areas into even more highly concentrated healthcare markets. Ron Peck and Nick Bonds break down how this concentration impacts the costs of healthcare and can drive costs upward for employers and employees alike. With fewer provider options, higher prices, and patients caught in the middle, Ron and Nick outline just a few of their concerns and discuss some of the tools health plans have at their disposal.

Is the Department of Labor Offsetting a Major Problem?

On January 3, 2024
As if Americans on employer-based health plans didn’t face enough obstacles in trying to obtain reasonably priced healthcare.

Time’s Up! It’s Gag Clause Attestation Season

On December 26, 2023
As the year wraps up and plans and TPAs around the country are scrambling to handle renewals, another challenge looms large in 2023 – the first annual gag clause attestation. As a reminder, the Consolidated Appropriations Act, 2021 (CAA) prohibits plans from entering into any contracts with providers and certain other entities that contain “gag clauses” – and requires them to attest annually that their contracts are free of them. The first attestation is due at the end of 2023, and it will cover the period of December 27, 2021 through December 31, 2023. The goal of the legislation is transparency, but it has glaring holes – contracts can’t prohibit plans from sharing certain information with other entities, but nothing requires them to be granted access to this information in the first place.

For Sickle Cell Disease Patients, Hope Has Arrived – but at What Cost?

On December 21, 2023
For generations of sickle cell disease (SCD) patients, the suffering has been unbearable – with no end in sight. SCD, an inherited genetic red blood cell disorder that affects hemoglobin, the protein that carries oxygen throughout the body, torments nearly 100,000 Americans (20 million people worldwide), a disproportionate number of whom are African-American. Among other symptoms, SCD often triggers chronic bouts of excruciating pain that require regular hospitalization, organ failure, strokes, and shortened life expectancy. Meanwhile, the only known cure for the insidious disease has been a bone marrow transplant.

Empowering Plans: P178 – Back to December (Phia’s Version)

On December 21, 2023
It is the last podcast of the year, and you know All Too Well that it is Phia’s 2023 year-in-review! Sparks Fly as Kendall Jackson and Corey Crigger talk about how Everything in PGC and Provider Relations Has Changed in 2023. If you need to catch up on anything from the No Surprises Act to Gag Clause Attestations, You Need To Calm Down and Stay Stay Stay tuned into this podcast episode. In addition to the big changes in 2023, we look forward to 2024 and ask, are you … Ready For It?