February 2012  |  Volume 3, Number 2

Contracts, Compliance and Research Updates
Medicare Part D: Second Disclosure Requirements

The second disclosure requirement is for entities to complete the Online Disclosure to CMS Form to report the creditable coverage status of their prescription drug plan. The Disclosure should be completed annually no later than 60 days from the beginning of a plan year (contract year, renewal year), within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.


For more information go to the "Disclosure to CMS Form" Section. It will be on the left-hand side of the linked Web page. This requirement does not pertain to the Medicare beneficiaries for whom entities are receiving the Retiree Drug Subsidy (RDS). 



Your PBM's Lipitor Strategy

Background: On November 30, 2011, the patent for Pfizer's high cholesterol medication Lipitor (atorvastatin) expired, clearing the way for competition from generic versions of this widely-used drug. Generics manufacturers Watson and Ranbaxy will be the providers of generic atorvastatin for a six-month exclusivity period. After the exclusivity period, atorvastatin will be available from multiple generics manufacturers----likely at significantly lower cost. See the FDA news release here.


Situation: During the six-month exclusivity period----through May 31, 2012----it is expected that generic atorvastatin pricing will be very similar to Lipitor. In an effort to retain as many of its customers as possible upon the introduction of generic atorvastatin, Pfizer is offering a $4 co-pay card program called "Lipitor For You."


Plan sponsors should contact their Pharmacy Benefit Manager to find out what, if any, changes will be made to their formulary tiers for this product.

Click here for the FDA's Web page, "Understanding Generic Drugs."



Prepare for the Participant Fee (Dorsey & Whitney LLP)

Under health care reform, plan sponsors of self-funded health plans and health insurance issuers will owe a new fee that is first payable for years ending after September 30, 2012. For calendar plans, this means the fee applies this year. 


Many questions about the fee are currently unanswered, including when it must be paid. Proposed regulations are expected on this and other matters. In the meantime, Notice 2011-35 provides information for plan sponsors and issuers to ensure they have properly budgeted for this expense.


For more information, click here.



Agencies Release ACA Final Rule and Guidance

The Departments of Labor, Treasury, and Health and Human Services have released final regulations under the Affordable Care Act (ACA) that require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to those with private health coverage.


Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:

  • A short, easy-to-understand Summary of Benefits and Coverage (SBC); and
  • A uniform glossary of terms commonly used in health insurance coverage.

The rule's effective date is 60 days after publication in the Federal Register (scheduled for February 14, 2012). The applicability date is generally September 23, 2012 (or the first day of the first plan year after this date, or the first day of the first open enrollment period after this date).


For additional information and the full IFEBP article, click here.

In This Issue
Contracts, Compliance and Research Updates
Conference Event


More information regarding Health Care Reform and other benefit resources is available on the HR360 website, available to BSG clients under the "Resources" menu of their HR Express website. HR360 includes new features such as step-by-step interactive guides which make the processes of hiring, termination, COBRA and FMLA so much easier. In addition, there are new online tools such as job description builder and salary benchmarking tool.

BSG subscribes to this service for your benefit. If you would like more information regarding this resource please contact your account management team at BSG. 

Recruitment for CDC's National Healthy Worksite Program open through 2/24/12

The Affordable Care Act's Prevention and Public Health Fund is supporting a $9 million national initiative to establish and evaluate comprehensive workplace health programs to improve the health of workers and their families. This initiative is called the National Healthy Worksite Program. In partnership with the CDC, Viridian Health Management (based in Phoenix, Arizona) will help an estimated 70 to 100 small, mid-size, and large employers create and expand workplace programs aimed at achieving three goals:

  • Reduce the risk of chronic disease among employees and their families through evidence-based workplace health interventions and promising practices.
  • Promote sustainable and replicable workplace health activities.
  • Promote peer-to-peer healthy business mentoring.

Each participating employer will receive a full-service wellness program during a 2-year intervention period. Based on employee needs, companies will establish a core set of three to five interventions from an available menu of options that include a mix of program (education and coaching), policy, and environmental support and that target physical activity, nutrition, and tobacco use in the employee population. After 12 months, a successful program will have gained the full commitment and support of leadership and employees, fully implemented all core program elements, collected baseline data, and created a health-promoting environment that establishes a culture of health within the worksite.


The program is limited to employers located in one of seven regions nationwide: Somerset County, ME (near Portland); Shelby County, TN (included Memphis); Marion County, IN (includes Indianapolis); Harris County, TX (includes Houston); Buchanan County, MO (includes Saint Joseph); Kern County, CA (includes Bakersfield); and Pierce County, WA (includes Tacoma). In addition, employers must meet the following eligibly criteria to be considered for the program:

  • 1,000 or fewer full-time employees
  • Offer health insurance to eligible employees
  • Demonstrate capacity and commitment to participate and to meet all program requirements
  • Cannot have an existing comprehensive wellness program in place

Employer Frequently Asked Questions can be found here.

To be considered for the National Healthy Worksite Program, eligible employers must complete the short information/certification form found at the program website. The certification period runs from 1/20/2012 through 2/24/2012.

Mid-Sized Retirement & Healthcare Plan Management Conference

San Francisco, CA ----  March 18 - March 21, 2012

Employers today face a host of challenges, not the least of which is managing a benefits program that is consistent with their organizational goals, complies with federal law, and doesn't play havoc with the bottom line. The University Conference Services, LLC (UCS) San Francisco Conference can help you stay on top of the issues that affect your two most important benefits: retirement and health care.


The Benefit Services Group, Inc. is pleased to be a repeat sponsor of this educational event. The program features an extensive agenda of 45+ sessions, including these that BSG will present:

  • Seatbelts Save Lives, and So Does Health Literacy* (Monday, 1:45 p.m. - 2:45 p.m.) Speaker: Sue Thomas
  • Green Light, Yellow Light: Starting a Wellness Program with a Yield for Health Care Reform (Tuesday, 2:15 p.m. - 3:15 p.m.) Speakers: Gerald W. Frye and Michelle Spehr

The program also features topical keynote sessions and speakers, including our own Gerald W. Frye, accompanied by Peter Garner, who will present a keynote address titled: Change Before You Have to: Use Health Care Business Intelligence to Drive Your Company's Success* on Wednesday at 8:30 a.m.

*Titles have been updated since brochure was published.


For more information, view the conference brochure or visit the UCS website.

Enlighten is published by The Benefit Services Group, Inc., (BSG®) and is provided free of charge to select BSG client representatives and associates.

By providing links to other sites, BSG does not guarantee, approve or endorse the information or products available at these sites, nor does a link indicate any association with or endorsement by the linked site to BSG.

The preceding is not intended to be and is not offered as legal advice. We are prohibited from the practice of law. Compliance is the responsibility of the employer or Plan sponsor and affected employees who should seek their own legal counsel regarding questions about information presented in this newsletter.

Copyright© 2012 The Benefit Services Group, Inc. BSG® is a registered trademark of The Benefit Services Group, Inc.