Phia Group

Medicaid Estate Recovery | Understanding the Implications

On April 3, 2024
Explore the implications of Medicaid estate recovery on families, including the emotional & financial burdens, & the proposed Stop Unfair Recoveries Act.

Lenmeldy | Exploring the Price of the New Gene Therapy

On April 1, 2024
Discover the implications of Lenmeldy, the world’s most expensive drug, and how its high cost affects access to treatment for patients with rare diseases.

The Phia Group Announces the Addition of the Renowned John Blaney as Their Chief Innovation Officer

On March 28, 2024
Canton, MA – Rarely can an organization with decades of industry leading ascendency truly claim to make a change that will both revolutionize its fundamental essence to the core, as well as deliver to its clients monumental improvements on top of what is already the industry’s best results. In other words, when does the best get even better? This is one such moment. March 30, 2024 will be remembered as the day that The Phia Group publicly announced the addition of the renown John Blaney as their Chief Innovation Officer.

Empowering Plans: P186 – Xenotransplantation: A Potential Game Changer for Self-Funded Plans

On March 28, 2024
Ham it up with attorneys Nick Bonds and Jen McCormick from the Phia Group as they dive into the groundbreaking world's first successful genetically engineered pig kidney transplant at MGH in Boston. Explore the details of this medical breakthrough, its implications for the healthcare industry, and the considerations for the future of dialysis, plan language, and stop loss provisions. Tune in to gain invaluable insights into the intersection of law, healthcare, and cutting-edge medical advancements.

Wegovy: Not Just a Weight Loss Drug

On March 20, 2024
Earlier this month, the wildly popular weight loss medication was approved in the US to help prevent life-jeopardizing cardiovascular events in people who are overweight, obese, and/or have a history of cardiovascular disease. The FDA’s stamp of approval for drugmaker Novo Nordisk to include cardiovascular benefits to Wegovy’s label meant it was the first weight loss drug to market itself in this manner. Now the million-dollar question (no pun, intended) becomes, will this label expansion make insurers feel more inclined to provide coverage? For good measure, will Medicare, currently barred by law from covering drugs for weight loss alone, be compelled to include Wegovy under its umbrella?

Empowering Plans: P185 – Weighing the Options

On March 14, 2024
Over the last twelve months we have seen major interest in GLP-1s (Semaglutide- Ozempic / Wegovy and Tirzepatide – Mounjaro / Zepbound). Although GLP-1s have been around for years as a treatment for diabetes, the recent popularity is due to their use as a weight loss drug. Join Ron Peck and Corey Crigger as they discuss the impact this surge in demand has had on health plans and consumers. Are health plans and consumers informed about the benefits and drawbacks of this drug? Are consumers too focused on the benefits? Are health plans too focused on cost? Find out as Ron and Corey discuss one of the hottest topics in the industry.

Significant Effects of a Recent Healthcare Cyberattack

On March 11, 2024
Explore the significant impact of a recent massive healthcare breach on benefit plans, including challenges in claims processing & potential regulatory relief.

Empowering Plans: P184 – State of the Union, 2024

On March 8, 2024
In his third State of the Union address, President Biden touted his administration’s record and outlined the issues he and his team will likely be campaigning on heavily as the 2024 presidential race kicks off in earnest. Sprinkled throughout were a number of policy wish list items, including some key healthcare initiatives that we’ll be keeping a close eye on in the coming months. Attorneys Brady Bizarro and Nick Bonds bring you some of the highlights in this episode of the Empowering Plans podcast.

How a Major Cyberattack Affects Healthcare Benefit Plans

On March 7, 2024
Learn about the indirect effects of a recent healthcare breach on benefit plans, including challenges with claims & potential future regulatory relief.

Empowering Plans: P183 – The Therapeutic Equivalence Approach: A New “Pill”ar of Contraceptive Coverage

On February 29, 2024
The DOL recently issued new guidance on the long-standing contraceptive coverage mandate, and this time they took a different approach. Instead of clarifying prior guidance or issuing novel interpretations of the law, the DOL is giving health plans an alternative way to comply with the contraceptive coverage mandate: either follow the prior guidance issued in 2022… or don’t! The DOL introduced the “therapeutic equivalence” approach, whereby plans can comply with the law in a different, potentially less-burdensome way. Join The Phia Group’s Kendall Jackson and Jon Jablon as they discuss this “therapeutic equivalence” approach to compliance, what it means for consumers, and what it means for health plans.

Millions Losing Medicaid Coverage | What You Need to Know

On February 22, 2024
Explore the implications of the recent Medicaid unwinding, which has led to millions losing coverage, & the challenges faced by vulnerable populations.

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.