Shopper’s Guide to Navigating Discount Drug Programs

It’s no secret that the cost of pharmaceuticals in the US is soaring. According a report published by Health Affairs in January 2019, the cost of oral and injectable brand-name drugs has increased annually by 9 and 15 percent, respectively, between 2008 and 2016. The research concluded that the rising cost of generic and specialty drugs were driven mostly by new product entry while the rising costs of brand-name drugs were a result of existing drug price inflation.

In the face of soaring drug prices, consumers have found an ally in their local big box stores, such as Walgreens, Walmart, Kroger, Target, etc. Roughly 4 out of 10 Americans rely on these programs to find savings for their prescription drugs. Generic drugs are often the focus, though brand-name and specialty drugs are also offered. Recent data shows that these drugs account for 85 percent of the retail pharmacy medicines prescribed in the US.

Retailers are able to sell pharmaceuticals at such deep discounts because they buy in bulk or they use membership fees to offset costs. Some stores say they will lose money through their pharmacy programs, but expect to make up the difference through sales elsewhere in the store, especially with big ticket items like jewelry and electronics.

There are numerous differences among the programs offered by each retailer. Some pharmacies require a membership or an annual fee, while others require only a doctor’s prescription. Some memberships need to be renewed annually, while others are more open-ended. Learning the differences among each can be vital in finding the cheapest and most convenient retailer.

Generic medications included in these programs may even be cheaper than an insurance co-payment. For example, if there is a $10 co-pay, but the drug needed is offered by a pharmacy for $4, the consumer  should be eligible for the cheaper price. Consumers should also ask the pharmacist how this coordinates with Medicaid and Medicare.

Consumers who prefer to shop at their local drug store should check and see if their corner pharmacy will match the price of the big box store.

When it comes to price matching medications, it’s important to do your homework. Determine which retailers offer the best value by asking what and who is covered and whether or not there is a membership fee. The savings can be significant.


October Medical Mutual Updates: Changing Payments, Deadlines, and Individual Market Updates

Medical MutualUpdating Medical Mutual Payments to Huntington Bank

Medical Mutual recently switched from PNC Bank to Huntington Bank for processing of premium and ASO-related payments. Group customers should now send payments to Huntington. Reminder letters will be sent to all affected groups ahead of shutting down the PNC Bank accounts prior to the end of the year.

COSE MEWA Columbus Territory Change

Effective November 1, 2019, the exclusive territory for the Columbus Chamber MEWA plan will expand beyond Franklin County and will include Union, Delaware and Licking counties. Any new group sold in those counties must be a member of the Columbus Chamber in order to enroll in the COSE MEWA health plan.

Two-Year Moratorium on Re-Entry to the COSE MEWA

Small groups choosing to leave the COSE MEWA and obtain other coverage will not be able to return to the COSE MEWA for two years. If a group wishes to return to the COSE MEWA before two years have elapsed, they will be charged a one-time fee of $1,000 per subscriber.

Pre-Submission Checklists

To help with submissions during the busy season, please complete your pre-submission checklist and send it in with your sold case documentation. Any submissions that are made after December 5, 2019, may not receive approval letters prior to the January 1, 2020, start date.

Health Insurance Tax

The federal government has not suspended the Health Insurance Tax for 2020, as they did in 2019. That means Medical Mutual will need to pass this tax along to their customers.

Medical Mutual Individual Market Updates

Medical Mutual will be offering ACA coverage in 12 new counties during plan year 2020. Click here to review the updated service area map. They have also added new $5,000 silver and $8,000 bronze deductible options that include office visit and Rx copays. Click here for the 2020 Plan Highlights flier for full details.

In addition, Medical Mutual has added statewide convenience walk-in clinics across Ohio and has expanded their Mercy HMO network with the addition of St. Luke’s hospital and more physicians.

Medical Mutual will discontinue the Promedica HMO network in Northwest Ohio. All members of that network will be moved to the Mercy HMO network.

Lastly, Knox Community hospital will no longer be a part of the OhioHealth HMO in Central Ohio.

Don’t forget to re-certify by the end of 2019 to receive renewal compensation for on-exchange plans!

Federally Mandated Fee Updated for 2020 Renewals

Since the Affordable Care Act went into effect in 2014, Medical Mutual has been subject to the Health Insurance Providers Fee, often referred to as the Health Insurance Tax or the Market Share fee. As a result, Medical Mutual has applied the Health Insurance Providers fee to all 2020 renewals.

Contact your Cornerstone representative with any questions about these updates.

Medical Mutual’s 2020 Small Group ACA Plan Grids Are Now Available

Medical Mutual’s updated plan grids, benefit highlight sheets, and Summary of Benefits and Coverage (SBC) documents are now available for the 2020 Small Group ACA rollout.

Updates to these plans include:

  • The elimination of the 1750 HSA plan. Current 1750 HSA members will be mapped into the 2800 HSA plan.

The addition of two HRA plans below:

  • Gold 5000 HRA with employer first contribution.
  • Silver 5000 HRA with employer second contribution.

Additionally, quoting for first quarter 2020 is now available in QRS. January 2020 renewals will be released soon.

MedFlex HMO Plan Options

2020 ACA Plan Options (Off Exchange)

Contact your Cornerstone representative for more information.

State Anthem Individual and ACA Groups Rx Change Coming

Members of Anthem’s Individual and Small Group Affordable Care Act health plans will move to their new pharmacy benefit manager, IngenioRx. Clients will receive letters regarding the change in November.

All Anthem members will use IngenioRx on January 1, 2020. Their pharmacy benefits don’t change as a result of the move to IngenioRx.

Members in most other plans, including grandfathered and/or grandmothered plans, already switched to IngenioRx.

Contact your Cornerstone representative with any questions.

ACA W-2 and SBC Reporting: FSA Focus

There are a number of Healthcare Reform requirements for plans with employer contributions to a health Flexible Spending Account (FSA) including:

  • Employers must report the total cost of any group health coverage provided to employees if they prepared 250 or more W-2s for tax year 2018. The cost is not taxable. Employer contributions to health FSAs are required to be included in W-2 Box 12, Code DD.
  • Employers must distribute a Summary of Benefits and Coverage (SBC) at open enrollment for most of their group health plans. If the plans include a health FSA as non-excepted benefits, the requirement to submit an additional SBC may be met by referring to the health FSA benefit in the SBC where applicable. There are some conditions  that define a Health FSA as an excepted benefit including:
    • You offer other group health coverage and
    • You do not offer employer contributions greater than $500 to any employee that is not a dollar for dollar match.

If the conditions above are not met, your plan is considered a non-excepted Health FSA plan, which is subject to the SBC requirement.

Click here to learn more about W-2 reporting requirements from the IRS.

Click here for information from CMS about SBC requirements.

Click here for information from the DOL about SBC requirements.

Earn Up to $25,000 With Oscar’s National Open Enrollment Broker Bonus Program

With Oscar’s National Open Enrollment Broker Bonus Program, you can earn a one-time bonus of up to $25,000 on top of your regular commission. Here’s how it works:

  • Enroll or renew 50 to 249 policies and earn $20 per policy.
  • Enroll or renew 250 policies or more and earn $40 per policy for all policies.

That means that enrolling 250 policies can get you a bonus of $10,000!

Click here to learn more about the program.

Contact your Cornerstone representative with any additional questions.

Don’t Miss the Deadline to Submit Client Referrals!

The Annual Enrollment Period for Medicare plans runs from October 15 to December 7, 2019, and the Open Enrollment season for ACA plans runs from November 1 to December 15, 2019.

We can help you! As a Cornerstone broker, you have exclusive access to the Agency Services Program, which enables you to refer clients that are outside your scope to ARC Benefit Solutions. The best part? You still get paid while we do the heavy lifting.

Referral Deadlines and Processes for the 2019 Enrollment Season

Through the busy season, we will continually provide the highest quality of service and support to your referred clients. However, due to the high volume of client referrals during the enrollment seasons, priority will be given to referrals received on or before November 30, 2019.

It is easy to refer to us! You can use the hyperlink below or the client can call us directly at our toll-free # 1-877-432-8803. A full process document is laid out in the link below for your reference.

Here are a couple things to consider during the busy enrollment season:

  • Referrals are managed first in/first out
  • A minimum of three client outreach attempts will be made, which will be a combination of phone calls and emails.
  • Priority is given to referrals received on or before November 30, 2019. Every effort is made to ensure outreach to the client occurs within 48 hours. Turnaround time may be delayed during peak periods as we get closer to December 15.

Incomplete submissions will be returned requesting missing information.

Review the referral process

Submit a referral

About the Cornerstone Agency Services Program

October The Dental Care Plus Group Updates

The Dental Care Plus Group Deadlines for 1/1 Business

To ensure member ID cards for January 1, 2020, groups are in the mail by January 1, DCPG must be in receipt of the group’s complete sold case submission, including employee enrollment forms or enrollment spreadsheet, by Friday, December 6, 2019.

2020 Dental Shelf Rates: Two-Year Rate Guarantee

DCPG’s 2020 dental shelf rates for your small (2-50) groups are now available for January 1, 2020 effective dates. New this year: shelf rates are guaranteed for a period of two years on new sales. There is no impact to the renewal strategy. All shelf rate documents can be accessed here.

Groups that have terminated coverage with DCPG are not eligible for the new sale shelf rates for two years from the date of termination.

DCPG Vision Shelf Rates for 2020

DCPG’s vision shelf rate plans are available to groups with 2 to 200 eligible employees for January 1, 2020 effective dates. These rates are guaranteed for a period of two years (on new sales):

Vision benefits are offered through their partnership with Avesis and accessible through a nationwide network of more than 76,000 access points. The network is made up of both independent and retail providers (Walmart, Sam’s Club, Costco, etc.). Additionally, benefit frequencies are based on plan year versus date of service.

Groups that have terminated coverage with DCPG are not eligible for the new sale shelf rates for two years from the date of termination.

Contact your Cornerstone representative with any questions.